Official Report 845KB pdf
The next item of business is a debate on motion S6M-21005, in the name of Liam McArthur, on the Assisted Dying for Terminally Ill Adults (Scotland) Bill at stage 3. I would be grateful if members who wish to take part in the debate were to press their request-to-speak buttons, and I call Liam McArthur, the member in charge of the bill, to speak to and move the motion.
18:24
This is a significant moment for the Parliament, so let me start by acknowledging some of those who have played their part in getting us to this point: the non-Government bills unit, who, like colleagues in the legislation team, are unsung heroes of this institution; my team, Amanda, Niamh and Ashley, and, before them, George, Peter and Jack, who have had my back throughout; and Dignity in Dying, Friends at the End and the Humanist Society Scotland, who have run the most amazing campaign while also supporting me directly. I remind the chamber of my entry in the register of members’ interests.
I acknowledge, too, those who responded in record numbers to my original consultation, many with the personal stories of dying Scots that I firmly believe must be at the forefront of our minds as we come to vote this evening, and who are represented in the public gallery. I also acknowledge the stakeholders who have engaged with me while also supporting the scrutiny process through giving evidence to a Health, Social Care and Sport Committee that carried out its responsibilities superbly.
I acknowledge colleagues across the chamber who have given their time to have conversations with me over the past five years and who, regardless of their position on the bill, engaged seriously and respectfully. It is often said that Parliament is at its best when it speaks with one voice. I believe that it is at its very best if it can come together when debating an issue upon which there is profound disagreement, and I commend colleagues for rising to that challenge. For me, that has been exemplified by the amending stages of the bill. Of the 175 amendments agreed to by Parliament last week, half came from members whom I fully expect to oppose the bill at decision time. That speaks to a determination among colleagues across the board to ensure that the bill, if it is passed, is the best that it can be.
In drafting the bill, I drew on international experience to ensure that it was tightly drawn and heavily safeguarded, and that it balanced the need for choice with the protections that patients, medics and the public rightly expect. Quite properly, at the health committee, and again last week, MSPs have had the chance to amend the bill to introduce further guardrails, additional clarity and stronger restrictions and requirements in a wide range of areas. That is as it should be.
I may have introduced the bill, but it is very much Parliament’s bill now. It feels invidious to pick out individuals, but I will throw caution to the wind and refer to colleagues who, at stage 1, were either opposed to the bill or whose support was certainly caveated.
Jackie Baillie has successfully introduced changes that reflect the priorities of Children’s Hospices Across Scotland, the Royal College of Nursing and hospices. Fulton MacGregor has been tenacious in speaking up for social work, securing changes that reflect the important role that those professionals must play in assessments and wider safeguarding. Ruth Maguire helped Parliament to reinforce protections to address concerns about coercion.
Meanwhile, Bob Doris secured so many amendments at stage 3 that my office now refers to the bill as “Bob’s bill”. Together with Miles Briggs, Bob Doris has ensured that the needs of palliative care services have been reflected in the debate around the bill, recognising the inevitable interaction between the two. That has allowed a light to be shone on a sector that is crucial and often misunderstood and undervalued.
Brian Whittle led the way on advanced care plans and the importance of using the bill to promote much greater discussion and early planning of people’s wishes at the end of life. Paul Sweeney ensured stronger requirements around signposting to social work and mental health services, an area that he has commendably prioritised. Daniel Johnson, whose forensic scrutiny of international legislation I referred to last week, lodged amendments that enabled debate on key issues and put in place further safeguards, including a prognosis period, mandating in-person meetings and toughening up reporting requirements.
Finally, Ross Greer built in advocacy support for those who need it while also, crucially, supporting my efforts to ensure that fundamental protections and training for medical professionals will have to be in place before the provisions of the bill can be implemented.
On the issues of legislative competence, I again acknowledge the work of the Scottish and United Kingdom Governments. They are neutral on the issue of assisted dying. However, once this Parliament voted strongly in favour of the general principles at stage 1 last May, both Governments worked at pace and in good faith. In record time, they reached agreement on a way forward that respects both the will of this Parliament and the provisions of the Scotland Act 1998. That agreement allows issues around medicines and medical devices to be dealt with via a section 30 order. The no duty/no detriment protections, as well as training, qualifications and experience requirements, will be taken forward via a section 104 order.
I recognise that colleagues, and some in the sector, are anxious. However, the fact remains that the provisions of the bill cannot come into force unless and until the section 104 order is passed. Of course, there are different views on the constitution and how the 1998 act might work in future. We will have ample opportunity to debate those views in the run-up to May’s election. For now, the reality is that we must deal with the 1998 act as it is, not as we would wish it to be.
In a sense, I agree with what Liam McArthur says about section 104 orders coming back to Parliament. However, does he agree that much of the detail about how the bill will work in practice will rest in the guidance and that Parliament is being given a yes or no option when many here might want to be able to scrutinise that detail?
I understand Daniel Johnson’s point. I worked closely with the British Medical Association on the amendments that I lodged after stage 1 to provide reassurance on the section 104 order.
On the point about guidance, any guidance or secondary legislation will have to be taken forward in consultation with the sector, which I fully expect will happen. Parliament should have confidence in that process.
I pay personal tribute to the cabinet secretary and wish him a speedy recovery. Neil Gray is the MSP I have known longest, a good friend and someone I respect enormously. It has not been easy for him to navigate the path that he has taken on the bill, given the differing views around the Cabinet table and across Government, but he has discharged those responsibilities unwaveringly. I hope that he will now feel able to vote—like every other member in the chamber—according to his conscience. To expect him to do otherwise would be unfair, unreasonable and unjust.
I said earlier that this is a significant moment for this Parliament—probably the most significant. I know how conflicted many colleagues feel and know that some may even still be unsure about how they are going to vote later. However, what we are doing is not breaking new ground and we are not doing anything that legislators around the world have not already done. I accept that every assisted dying law is different and that each must be tailored to meet the circumstances of its own jurisdiction. However, I do not accept the assertion that, were the bill to be passed and the choice of assisted dying made available in Scotland to those who meet the strict criteria, it would operate at odds with what we see in states and countries that have similar models based on terminal illness and mental capacity.
Dr Andrea Bendrups, the president of Voluntary Assisted Dying Australia and New Zealand, a body representing health professionals, wrote to MSPs last week. Many VADANZ members have trained, or worked in, the UK, so our debate is being watched closely there. In her letter, Dr Bendrups writes:
“It’s been notable that the arguments being made against a change in the law are in fact the same arguments that were made over many years in Australia and New Zealand.
None of the fears raised have been realised in practice—eligibility criteria have not been expanded; proper assessments to confirm capacity and the absence of coercion have meant not all applicants are found eligible; and palliative care has flourished. Regular scrutiny and oversight show these laws are safe and are fulfilling their aims.”
Addressing concerns about doctor-patient relationships, Dr Bendrups goes on to say:
“As clinicians we know how helpless we can sometimes feel when palliative care has reached its limits and when our patients ask for help that we cannot offer.
The change in the law on assisted dying meant we can now deliver a fuller range of choices to dying people in a more transparent and regulated manner. The integration of voluntary assisted dying into our existing health system has meant that end-of-life care is now safer and fairer than ever before.”
I do not underestimate how difficult a decision this is for colleagues, even for some who are very clear about how they are going to vote and why. However, we must recognise that not passing the bill would have consequences. The issue will not go away; indeed, the numbers affected will only rise. All that we will do by putting off changing the law is push decisions overseas and behind closed doors.
As I did at stage 1, I urge MSPs to have the voices of dying Scots at the front of their minds when they come to vote. To help with that, I will conclude with the words of Lisa Fleming, who visited Parliament recently to share her experience of living with secondary breast cancer for the past nine years. Lisa explains:
“Sadly, choosing not to support this Bill is a vote for continuing the well-established risks and dangers present in the status quo. As with many things there is a cost of inaction. In this instance, the price of MSPs’ uncertainty would be mine to pay.
Voting down this Bill is not risk free. The consequences are not hypothetical. They are lived every day.
To the concern this would lead to an enormous change in healthcare, I disagree. I can already choose to refuse treatment whenever I wish, even if that treatment would save my life.
I can legally choose to hasten my death by voluntarily stopping eating and drinking, literally starving myself to death.
Doctors can already administer doses of morphine and other palliative medicines that would hasten my death as long as their motive is to alleviate my pain. Legalising assisted dying would not change my relationship to my doctor—it would allow me to be open and honest about what I want and ensure I wouldn't be forced to suffer against my wishes.
I fight every day to live a little longer. But every day I have, contains fear over how I will die. If I knew I had the choice of an assisted death at the end, I could live the rest of my life without that fear.
Please think of me as you cast your vote.”
Presiding Officer, I urge members to listen to Lisa and the many, many like her who desperately need us to give dying Scots more choice, more dignity and more compassion.
I move,
That the Parliament agrees that the Assisted Dying for Terminally Ill Adults (Scotland) Bill be passed.
18:36
Unfortunately, Neil Gray, who up until today has led on Liam McArthur’s Assisted Dying for Terminally Ill Adults (Scotland) Bill for the Scottish Government, was admitted to hospital yesterday. I am pleased to say that he has now been discharged, but he is unable to take part in this evening’s debate. I will be keeping my remarks on behalf of the Government short, and I remind members that the Government is neutral on the bill.
The bill has been carefully and properly considered by Parliament, through the actions of Mr McArthur as the member in charge of the bill and through the contributions of all members. There are strongly held and passionate views on both sides of the debate, but I believe that members have taken a considered and courteous approach so far, and I am sure that that will continue this evening.
I would also like to note the work of the members of the Health, Social Care and Sport Committee and the parliamentary staff who have supported them. They have had a larger role to play than most through the bill’s first two stages and have considered these profound matters with the care and seriousness that they deserve.
Let me now turn to the role of the Scottish Government. As members are aware, we undertook to respect the will of this Parliament by engaging with the UK Government to try to resolve the issues of legislative competence that we had identified with the bill as introduced, which we set out in our September 2024 memorandum, as well as with provisions that were added to the bill at stage 2.
During the stage 3 considerations, Liam McArthur reminded members that he, too, was aware of the need to ensure legislative competence, and I appreciate his acknowledgement of the constructive and timely work by both Governments in that regard. As Neil Gray has said to Parliament, that engagement, which took place in good faith, resulted in a section 30 order that modified schedule 5 of the Scotland Act 1998 to allow the Scottish Parliament to legislate on the identification and regulation of substances and devices for use in assisted dying in relation to the bill. Both Parliaments and the Privy Council have approved the order, and it came into force on 11 March.
That engagement also resulted in an in-principle agreement with the UK Government to take forward a section 104 order, should the bill be passed, although it would be for a future Scottish Government and the UK Government to work together on the detail of that order. That in-principle agreement covers making provision consequential on the bill for individuals and practitioners to opt out of participating in assisted dying and providing appropriate employment protections. It also covers the consideration and making of appropriate provision to specify the training, qualifications and experience that would be required for participating medical practitioners and nurses.
Through stage 3 amendments that were agreed to by the Parliament last week, the changes that were necessary to address the issues of legislative competence with the bill have been made.
Another potential issue was that amendments at stage 3 could have brought the bill further outwith competence. That is why the Government provided a commentary on the amendments, in which it highlighted technical, deliverability, legal and legislative competence matters, to help members in making decisions on the amendments that they might wish to accept or otherwise. We also did that at stage 2, and, yesterday, we provided a final short commentary on the bill to support MSPs in making their decision.
We all know the huge sensitivity of the subject that is before us, the complexity of it and the weight that is on our shoulders as we make our individual, personal decision on the bill. It is now for members to cast their final vote in the decision before us.
18:40
This will be my final speech in this place before stepping down next week after 10 years. It is a short speech and, of course, it is not political. However, that is okay, because what we are debating is not about me. The debate and the days that we spent agreeing to amendments last week are for terminally ill people who are pleading with us to be given the choice to die a dignified, pain-free death of their choosing.
I respect those members who do not share my views on the bill. I do not agree with their views, but they have a right to hold them. They have the choice to vote for or against the bill. That is the point. We, in this Parliament, have a choice. Terminally ill people who are terrified of what they might face at the end of their lives do not. Who are we to deny them that choice and to put our values and preferences before theirs because we have the power to do so?
If the bill is passed tonight—and I hope with all my heart that it will be—it will be the most heavily safeguarded bill in any jurisdiction. The respectful and collegiate way in which Liam McArthur and his hard-working team have brought the bill to this final stage is to be commended. No one has worked harder, and, after last week, no bill in any jurisdiction in the world with assisted dying will be more heavily safeguarded.
The bill has always been about creating a compassionate, regulated, safe and legal option for terminally ill adults who choose to end their suffering. We know that many terminally ill Scots face a bad death and are forced to contemplate a series of desperate, traumatic decisions that do not belong in a compassionate 21st century Scotland. International evidence proves that assisted dying is safe and compassionate and that it is a comfort blanket for those who are able to choose whether or not to use it. What makes Scotland so uniquely different that it could not be the same here?
The most recent polling found that 81 per cent of people in Scotland want assisted dying to be introduced as an option for those who are diagnosed with a terminal illness. There is clear majority support for the bill across every constituency, so Scotland is not on the fence on assisted dying.
I said earlier that the bill is not about me or any other member at this time, so I want to give terminally ill people who have had all agency stripped from them by their illness a voice. One woman opened her heart and said:
“Assisted dying would be a lifeline. It would let us live the rest of our lives in peace, making precious final memories with our loved ones, without the constant dread of how our lives will end … Voting against this Bill will not stop us from dying, but will deny us a lifeline to a safe, peaceful death surrounded by our loved ones.”
Too many families are left traumatised by what they have witnessed at the end of a loved one’s life. Now is the opportunity to make things right for those who have died, so that no one has to suffer as they did. The status quo abandons people at the moment they most need compassion, safety and support. The most dangerous thing that the Parliament can do is nothing. In the name of humanity and for those who depend on us, I urge members to support the bill.
18:44
We have finally reached the last stage of the Assisted Dying for Terminally Ill Adults (Scotland) Bill. I am sure that, for many, it has been a long and uncomfortable journey. We have all had to consider our own mortality and that of our constituents. Looking death in the eye has never been easy, and we must always consider the fragility of life. However, let us be clear: in my mind, life is always about living.
I have heard much in the debate about why people should have the choice. In principle, I agree. However, choice can be made only if there are genuine options. Those options must include palliative care, for which my colleague Miles Briggs has fought hard. However, the sad fact is that more than 14,000 Scots a year die without proper palliative care, and a lot of money would be needed to provide that. Thus, to some, it may be easier to opt for death, knowing that palliative care close to their home and family is unavailable. That is not a choice. Before we consider helping those people to die, we must know that their end of life is fully provided for and funded—which, at the moment, it is not.
Funding is a key issue when it comes to the bill. We know that funding for it would come from the existing national health service budget. The Government has been clear that it has no idea of the costs, but it admits that they would be high, and it says that a level of reprioritisation would be required. That means that existing services would face funding cuts. Which treatments would be cut? Would they include cancer care, palliative care, elective surgery, or perhaps even screening for breast or bowel cancers? It is just not good enough to say, “Pass this bill, and then we’ll work out how we’re going to pay for it.” We need clarity now.
On clarity, if the bill is passed, what will happen to those who want to opt out of providing an assisted death—from doctors to nurses to care homes to palliative care homes? Many of those, like me, will have no religious drivers but will know in their hearts that they do not want to be part of the process. The part of the bill that would have protected conscientious objectors has been removed, in order to make the bill competent. That worries me. Civil servants and ministers at Westminster will be able to decide on how to protect Scots in what is specifically a Scottish bill. Here, in our Parliament, there will be no choice on the exact detail. That not only seems wrong but is wrong.
I will turn to the area of the bill that gives me the greatest concern: coercion, including self-coercion. I find that a really difficult area to discuss. When one’s grip on life is fragile, the mind does somersaults. However, once someone gets past thinking that it might be easier and kinder to their family to die, the overriding consideration will turn to living. Treatment options and pathways for care are, rightly, the top priorities. However, the bill would give doctors the right, in terminal cases, to say, “Death is available.” I believe that the last thing that we should do is suggest that ending life is a form of treatment.
Presiding Officer, when we despair we need hope. Death offers no hope. Treatment and care offer hope. Let us provide and fund that care before we legislate to end life. Until we do, I am afraid that I cannot support the offering of assisted death; to me, that is morally wrong if we cannot allow for an assisted life.
18:48
I thank Liam McArthur for the considered manner in which he has advanced the bill. In my 19 years in the Parliament, this has been the single most difficult matter to determine.
I recognise and understand that many colleagues have known from the outset how they would vote today. I have not. As we debated the bill at stage 1 last May, I did not know how I would cast my vote on that day. Indeed, only in the past few days have I come to determine my final position. I admire and perhaps even envy those who approach the bill with absolute certitude on the best way forward. I respect those who have such certainty. Even at this stage, I have found myself grappling with how best to make the right decision.
I have approached the bill with an open mind throughout its passage. The first principle under which I have considered the bill is whether a person should be able to command autonomy in decisions that impact them and their lives most directly.
That is a principle that I broadly agree with, and it is a principle that lends itself to supporting the bill. Indeed, it was one of the reasons why, having heard the debate in May, which many colleagues took part in, I felt able to support the bill in principle at stage 1. However, it is not a principle that sits in isolation from other considerations, and, in contact with the many constituents who have been in touch with me about the bill, I have always been clear that those are just as important. The other primary areas of importance are tightly defining eligibility, protecting the most vulnerable in our society and protecting the interests of clinicians and medical professionals.
I recognise that, last week, we made a great number of changes to the bill, which have gone some way to further improve what was in it. The short time that is available prohibits me from mentioning many of those, but the one that I am clearest on is the requirement to have a reasonable end-of-life prognosis of six months. In my view, that was an essential change.
However, I have lingering concerns. I was disappointed that Daniel Johnson’s amendments that would have absolutely required it to be in the hands of the patient to first raise the prospect of an assisted death with a medical professional were not agreed to. Any new legal right to an assisted death changes the context of patient and doctor conversations and creates a new dynamic. I believe that, in such circumstances, the amendments that Mr Johnson lodged were very important, and their being disagreed to has been an important part of informing my thinking.
I was disappointed by the rejection of the amendments that sought to create institutional opt-out. That would have been a helpful provision.
I am also concerned that Parliament has found itself in the unsatisfactory position of not being able to legislate for the protection of conscientious opt-out for medical professionals. I recognise that we are up against the limit of the Parliament’s legislative power, but having to remove those provisions and rely on the section 104 order process, which would leave it to the UK Government to determine how that would work, is of concern to me. In my view, the UK Government should have agreed a section 30 order to enable the Parliament to legislate to provide clarity.
I appreciate that it is argued that we can reasonably expect the UK Government to put in place the provisions that we would require to be satisfied that the position of the medical workforce was protected, but the fundamental point is that we do not know what those would be. That concerns me, and the inability to demonstrate how that area would work, along with the other areas that I have highlighted, leaves me at this time, with some sense of regret, unable to support the bill.
I know that that decision will disappoint many in this chamber and beyond, although I am just as sure that the alternative would equally have disappointed many others, but it is the decision that I have come to sincerely and that I rest upon.
18:52
When I was elected in 2021, I was undecided on the issue of assisted dying, although I knew that a decision was likely to be made on it in the current session of Parliament. Over the five years of this session, I have learned from colleagues and constituents that being a member of Parliament is far more about listening than it is about speaking, and I have listened to the voices of my constituents who have sat at bedsides and suffered as relatives have died the most difficult of deaths. Those families have our empathy and our sympathy, and it is a privilege to be entrusted with their stories.
Today, I believe that MSPs must listen to those who know the messy, emotional, painful and inevitable business of dying best of all—those who have seen thousands of deaths rather than our terrible handfuls, and who have the duty of seeing the aggregate as well as the individual. We should acknowledge together that those who would be most involved in delivering the process of dying that we will vote on today are asking us to vote against it, from the patient’s trusted general practitioner to the psychiatrist who assesses for capacity, the pharmacist who provides the drug and the palliative care staff who are there at the end. All of their esteemed professional bodies have considered the bill and are asking MSPs to vote against it tonight.
Like many Dundonians, I have said goodbye to beloved family and friends in Roxburghe house, which is an outstanding palliative care facility in the verdant shadow of Balgay Hill in Dundee. This morning, I was struck by the testimony of Dr Martin Leiper, who was the lead consultant physician in palliative medicine in Tayside and who led that hospice during his 35 years in our NHS.
Of our vote tonight, he said:
“I’m really worried about the effect that it might have on my former place of work, whether its staff would be willing to work in an environment where palliative care was delivered and there was also the option for life to be ended. I worry that some staff—fantastic staff—would no longer go into work in that sort of environment.”
I know from speaking directly with staff that that would be true and that a delicate balance would be broken.
Instead of improving palliative medicine, which we all have agreed must improve, the bill risks harming it. The Government reiterated just yesterday that the costs of the bill will be high and that no new money is available to our NHS.
Beyond principle and practicality, there is a lack of safeguards and a fear of coercion in our deeply unequal society, in which the vulnerable and the disabled might easily see themselves as a burden and in which women suffer daily at the hands of men. On top of all that, expert caring staff are opposed to the bill because there is a huge hole at its heart where protection for those dedicated professionals and their care of patients should be. Ceding the process to backroom officials is an unsafe dereliction. It is the job of elected representatives to hear the voices of the people, to balance competing claims and to act in the public interest.
We have exhausted scrutiny of the bill, which the vote at stage 1 allowed to happen. However, to those who agreed with the principle and must now judge the practicality, I say, please, not this bill.
18:56
I start by recognising the hard work of Liam McArthur and everyone on his team, as well as the high quality of debate, which other members have acknowledged. Members on both sides of the principles that the bill raises have engaged constructively and respectfully, and I am convinced that the result is a bill that is stronger, thanks to the scrutiny of the Parliament.
I know that some members’ opposition to the bill is very strong. For some, that would not have changed, regardless of the detail. I respect that position, but I must take the opportunity today to speak primarily to those who have concerns but who are open to the principle—those who accept the case for a change in the law but who need to know that the system that we are creating would be safe, compassionate and robust.
I ask members to consider two key points as they reach their final decision. The first is that this is not a choice between the bill and some ideal status quo. In today’s Scotland, far too many of those who reach the end of their lives in the most difficult of circumstances experience fear, unbearable suffering, a desperate desire to have control of what is happening to them and, indeed, pressure or coercion in different forms to make choices that they would not make freely. Even with the very best palliative care, which is something that we all support, that is still the case. The bill is not an alternative to something benign. It is an alternative to a status quo that we should consider unacceptable and unsafe, and which too many people face not only without choice but without the protections that the bill contains.
Secondly, I ask members to reflect on the very fact that our debate has heard about the different principles and values on which we base our choice as legislators, as well as the different values that inform the views of our constituents on both sides of the debate. The different values that we bring to the debate reflect the different values by which we live our own lives and which inform every choice that we make, including as we look ahead to the uncomfortable truth that we will all, each of us, one day, face the end of our own lives.
The fact of the different values by which we live is, for me, the central reason why we must respect the right of people to make choices on their own terms, including choices that we might never make for ourselves—even choices of which we might disapprove. That is at the heart of what it means to be a creature that is capable of choosing.
I know that there have been legitimate and valid concerns about getting the detail right in the bill. I believe that the work that Liam McArthur has done and the amendments that the Parliament has made give us the chance to allow choice, with meaningful protection for those who need it. The bill would give Scotland the most safeguarded assisted dying system in the world. Working in tandem with palliative care—never against it—it would have support and advocacy at its heart.
Will Patrick Harvie give way?
I am not sure whether we have time in hand.
There is time for a very brief intervention.
I will give way.
Would the member accept that a number of the safeguards that are present in many parts of Australia are not present in the bill in terms of oversight? I am not sure that it is correct to say that the bill before us would be the most safeguarded legislation.
In looking at the various systems around the world, I do not believe that there is one that has this package of safeguards and measures. However, every member must make that judgment for themselves. The bill will have support and advocacy at its heart, and its provisions will be available only for those who are truly reaching the very end of life. It contains within it the path to the most robust protections for those who feel the need to exercise a conscientious objection, with complete democratic control here in this Parliament. The bill will not come into force unless MSPs are satisfied with the treatment of reserved matters.
This bill is the path to the safe, compassionate and controlled system that will give meaningful choice, with protection for those who need it most, and that will meet the public will for a change in the law. I urge members to vote yes.
19:01
I start by echoing the tributes that have been paid to my friend Liam McArthur and his excellent team for getting us to this stage.
Throughout our consideration of the bill, I have listened with quiet awe and, at times, great sadness to the testimony of colleagues and constituents who have lost the people they love in the most brutal and unforgiving of circumstances. I have nothing to match that. I have no comparable experience from my own family or friendship group to offer the Parliament, and I am profoundly grateful for that, just as I am grateful for the strength of those who have shared those stories, framing the debate around the human at the heart of this, speaking about their loss of agency, their loss of dignity, the agony of it and the terror of it, distilling into heartbreaking clarity what really matters at the end and how, all too often, people are robbed of so much of that in their final days.
Medical culture and practice have led us to a point where life can be foreshortened, but only with the removal of sustenance and fluids. That is the barbaric and inhumane compromise that we have settled for, where emaciated bodies are made as comfortable as possible but are still left to a lingering death that can take many days. The provisions in the bill offer patients in the end stages of life a far more gentle and dignified alternative to that—but only if they are terminally ill, only if they are aged 18 or over, only if they have mental capacity, only if they are acting of their own volition and only if their clinicians agree that they have fewer than six months left to live. That is a powerful matrix of safety, and the member in charge has drawn from the very best practice of those jurisdictions that have gone before us.
We benefit from that because we are not pioneers in this. More than 300 million people live in jurisdictions that already offer assisted dying. We should consider that, over the decades, not a single one of those countries or territories has ever reversed that decision. If this were so readily exploitable or dangerous, there would be examples of repeal—but there are not.
The narrow scope and significant safeguards of Liam McArthur’s bill as introduced have only been strengthened and enhanced by the quality and depth of the amendments that we have made as the bill has moved through the Parliament. The guardrails around the bill are unprecedented. This is one of the safest approaches in the world.
Please do not vote against the bill because you are waiting for a safer one. In this moment of final decision, all that is left for us to decide is whether we support the idea of choice at the end, or we do not. I respect and have great admiration for many of those who have spoken in opposition to the bill, but we have made sure that, if it passes, you will never be forced to choose it. I ask members: please do not take the choice away from the rest of us.
I have no real fear of death itself, but I have abundant fear of dying. Uncontrollable breakthrough pain frightens me. Asphyxiation and an inability to swallow frighten me. More than anything else, the loss of my identity and the lack of recognition of those I love frighten me.
I want to be able to choose a different end and to remain the author of my life’s story until the very last word, but the law as it stands makes death a lottery—a potentially cruel and terrifying uncertainty that all too many Scots meet the sharpest edges of. That is why, with all my heart, I hope that we change the law tonight.
19:05
I thank Liam McArthur for all the work that he has done on the bill.
In my notes, it says, “Try not to cry during this debate,” because it means quite a lot to me. I often use songs and music to describe how I am feeling and to tell people how I feel. It is often said that music is the soundtrack of our lives. I used that phrase in the stage 1 debate to express my love for Stacey—I kind of do that a lot. After 30 years of marriage, it is probably less romantic than it was back in the day.
It was American broadcaster Dick Clark who first used the phrase “Music is the soundtrack of our lives.” When we hear certain songs, we are instantly taken back to when we first heard them—the school disco, the relationship that was fleeting but powerful or St Mirren winning the cup. That last one might just be me.
Music takes us to the moments in our lives that shaped us. When I hear “All I Ask of You” from “The Phantom of the Opera”, I see Stacey walking down the aisle on the day we got married, looking gorgeous. When I hear “God Only Knows” by the Beach Boys, the opening bars melt my heart, and I am thankful that Stacey is part of my life. I have become the man I am because of her.
As members know—I said this during the stage 1 debate—Stacey lives with multiple sclerosis. Like many people who live with long-term conditions, she carries it with remarkable strength, even if life is not always quite as rosy as she sometimes leads us all to believe it is.
There is a song that means a lot to Stacey: “Smile”. The melody was written by the brilliantly creative but flawed genius Charlie Chaplin, and the lyrics were added later and made famous by Nat King Cole. The lyrics say:
“Smile though your heart is aching”.
In many ways, that has become her anthem.
Stacey lives with MS, high blood pressure, asthma and osteoporosis. MS itself will not kill her, but it makes her more vulnerable to other illnesses that could come later, and yet she smiles. She smiles because we have each other, because we have our children, James and Jessica, and because we have our four wonderful grandchildren, who are soon to be joined by a fifth. She gets through the hard times because she has so much to live for. When Stacey talks about that song, she is not talking about the end of life; she is talking about living it—every day that she possibly can.
However, Stacey also says that, if the worst should ever come to her—if she was ever facing unbearable suffering at the end of life—she would want a choice.
There is another song that means the world to me: “No Matter What” by Boyzone. Please do not judge me. I played that to my daughter, Jessica, when she was wee. It was my way of telling her to be true to herself, to grow up into her own woman and to know that, no matter what, she would always be loved.
That is what it all comes down to for me. My wife and my daughter are two of the most important people in my life. We all have these stories—every one of us—but all stories inevitably reach their final chapter. For many, the end comes with peace and comfort. For others, it comes with profound suffering, a loss of independence and a loss of dignity.
The question is whether compassion has a place during the final bars of life’s soundtrack. We cannot control every note, but we can decide whether the final notes are shaped with humanity, dignity and choice.
I agree with those who tell me that we need better palliative care. My mum, Elizabeth, spent the last few days of her life in the Accord hospice in Paisley. Two days before she died, Stacey and I spent a whole Saturday afternoon creating a playlist, which included songs by the Beatles, Tammy Wynette, Patsy Cline and Willie Nelson. My mum liked two types of music: country and western. We had a great day, but a week later I was carrying her coffin down the aisle of Woodside crematorium to “Blue Eyes Crying in the Rain” and her personal anthem, “Stand By Your Man”. When I hear that music, I remember that sunny day.
Music really is the soundtrack of our lives—the songs that we hear before the memories we carry, the people we love, the lives we build and the moments that shape us. Stacey says, “Smile though your heart is aching.” That is how so many people live their lives: with courage, resilience and love for the people around them.
Every life—no matter how rich its soundtrack is—eventually reaches its final chapter. When that moment comes, the question before us today is simple: should those final notes be written only by illness and suffering, or should compassion, dignity and choice have a voice as well? If music truly is the soundtrack of our lives, the final note should be written with compassion and by the person themselves.
19:10
I wish to make a declaration of interests: I am a practising NHS general practitioner, who is registered with the General Medical Council, and a member of the British Medical Association. In addition, I chaired the medical advisory group for the Assisted Dying for the Assisted Dying for Terminally Ill Adults (Scotland) Bill. Also, I am a practising Hindu.
This debate touches on some of the most profound questions that any of us will ever face—life, suffering, dignity and death. I want to express my sincere respect for those colleagues and members of the public whose religious, ethical or philosophical compasses make it deeply difficult to contemplate supporting the bill. Those views are sincerely held and deserve respect in the chamber. I say that as someone who shares some of those internal tensions—as a practising Hindu, I wrestle with the philosophical, ethical and spiritual aspects of my faith when I consider legislation such as this. These are not abstract ideas to me; they are part of my own moral framework.
However, this Parliament is not a theocracy. Our responsibility is to inquire, to investigate, to debate, and, sometimes, to struggle with difficult questions so that we make decisions that improve people’s lives. That is why I came into politics.
We cannot be out of touch with the country that we all serve. Scotland today is largely secular. We live in a pluralistic society with many different moral perspectives, and 81 per cent of the public support assisted dying.
We, in this chamber, and all those watching share two things: we are born and we will die. All of us—no exceptions. We control all aspects of our lives, but we have no control over how we die. People die alone, scared and in agonising pain. As a patient told me, “I wouldn’t let a dog die like this. Why am I having to suffer like this?” That patient can choose to starve herself or to stop drinking and to die horrifically, but she could not choose to die with dignity or painlessly. Let us here, today, give people a real choice over how they die.
Having chaired the bill’s medical advisory group, I believe that we have before us a serious and sound piece of legislation. We must also be honest about the reality that already exists. Today, the option of a peaceful assisted death is effectively available only to those with the financial means to travel abroad. Those without such means often face prolonged suffering without the same choices, and that inequality should trouble us.
This bill is also not and must never be seen as an alternative to high-quality palliative care. As a GP, I have seen the extraordinary compassion and skill of palliative care teams. They do remarkable work, and I will continue to advocate strongly for greater resources in this area. Palliative care must remain a cornerstone of how we care for people at the end of life, but choice matters.
For some patients, despite excellent palliative care, suffering cannot always be relieved. For those individuals, the dignity of choice at the end of life is something that many Scots believe should be available.
The bill represents years of work, consultation and scrutiny. It offers compassion, safeguards and dignity for those who face the end of life.
If the bill falls today, it will not simply be a procedural moment; it will be a lost opportunity to help those suffering and dying who have no voice. For those reasons, and with respect for colleagues who will reach a different conclusion, I believe that this is a good bill, a sound bill and a bill that deserves the support of this Parliament.
19:15
In my five years as an MSP, I have had the great honour of hearing directly from people across my region and across Scotland. Many of those people have experiences well outside my own, and I value all those interactions and take them very seriously. I therefore want to thank everyone who has contacted me about the bill.
I am here to serve, and that is exactly what I intend to do today. Few groups have affected me as much as those pleading with us to pass the bill. What I have come to understand is that choice at the end of life really matters. The experience is one that any of us might encounter in one way or another; however, until we do, it can seem like an abstract or far-off consideration. We cannot allow ourselves to imagine that we might have to consider assisted dying.
People who have had this experience, or who are having this experience as we speak, are watching us today, awaiting a vote that signals to them that their concerns have been heard and that their lives remain their own. Those same people watched last week as we constructively debated the issues and assessed the amendments—the longest such process that we have had, certainly in my time here at Holyrood. No one can say that the bill has not received serious and considered scrutiny, and I thank my fellow members for that.
I remind colleagues in the chamber that there is widespread public support for legislation on assisted dying. Are we, as parliamentarians in Scotland, going to simply ignore the fact that public opinion is moving towards such reform? I truly hope not. I believe that we need this legislation and that to turn our back once again on compassion and choice would be a grave mistake, driven by fear.
Polling suggests that around 76 per cent of people across my South Scotland region support legislating on assisted dying; indeed, the figure is broadly similar in every region. I want to be clear: this bill is about choice; it has strong public backing; and it has received unprecedented scrutiny and constructive debate. That is how democracy should work—it is the basis for good legislation that will stand the test of time. In that spirit, and in line with the principles that I have strongly held since I worked in the NHS, I will cast my vote today for the people who are suffering now, for those who will suffer in the future and for everyone who simply wants a fair and compassionate option in the likely final six months of a terminal illness.
I entered politics to help people and to empower them, and the bill does both. It might not be a comfortable or an easy subject—I accept that—but this is all about taking a compassionate approach that best serves the complex experiences of so many people across Scotland.
At times, I have been dismayed at how little meaningful legislation makes it through the chamber. A great deal of time, public funds and people’s hopes are invested in our democratic processes, and I fear that, due to excessive caution or needless delay, we do not provide the public with many examples by which they can measure our worth. Today, we can provide such an example.
I will close by offering my thanks to Liam McArthur MSP and his team, who have done such great work in navigating the bill through the Parliament. Without that steadfast and constructive approach, we would not be at this stage to begin with.
I urge my fellow MSPs to please not delay compassion or delay the ability to help others. Let us pass this historic bill and end this session having truly changed Scotland instead of just maintaining the status quo. Let us give dying people the chance to decide their last moment for themselves.
19:19
It has been said many times during this stage 3 debate that we are dealing with the most important decision that we, as parliamentarians, have taken, and I want to thank Liam McArthur and all his team for the way in which we have taken the bill through Parliament.
The decision that we make this evening will profoundly change the very fabric of our society and we should all consider that carefully when it comes to decision time.
Disabled people are frightened, and I ask my colleagues to put themselves in their shoes and my shoes. Imagine that you relied on your family and friends to make daily sacrifices to help you to get up, dress and be ready for the day. Imagine that you had been told by many people, including a number of politicians, that you were a burden on society and that the benefits that you rely on to survive could be better spent elsewhere. I want you to imagine that, on numerous occasions, you have heard the words, “I’d rather die than live like you.” How do you think you would feel, watching this debate? I think you would, rightly, feel terrified.
I know that those on the other side will say that the bill will affect only those with terminal illness, but, as we have seen time and again in other jurisdictions, the bill would mark the beginning of the story but not the end. Take Jersey, for instance. Its bill was passed not even a month ago and there have already been attempts to broaden the criteria by which someone there becomes eligible for an assisted death.
In passing the bill, we would be opening a Pandora’s box and the effects on the most vulnerable people in our society would be devastating. Despite what we have heard from those on the other side of the debate, there can be no meaningful protection against coercion and we cannot legislate against the feeling of being a burden. We cannot legislate for the throwaway comments that make me and others feel that our lives are worth less.
I am very fortunate. I have had a loving family. I have a superb wife and loving children who would never let me go through that, even if I was at a low point, but many in our country are not so fortunate. The protections in the bill are not good enough and can never be good enough.
Colleagues—friends—I am begging you to consider what the consequences of passing the bill would be for the most vulnerable in our communities. Do not let the final act of this session of Parliament be a disappointment to them and to future generations.
19:23
If the bill to legalise assisted dying is not passed today, many people who have led a dignified campaign in support of a change in the law will be deeply disappointed. Likewise, should the legislation become law, many others will feel just as much disappointment and, in particular, many of our disabled constituents will be shaken by that outcome.
As all members have done, I have received heartfelt pleas from constituents on both sides of the debate. My approach to the bill has been to seek to amend it as best I can to bring in some safeguards, even though I am not convinced of the level of reassurance that such safeguards will offer. I sincerely thank Liam McArthur for his constructive engagement on amendments at stage 3. I also thank the Scottish Partnership for Palliative Care, which I worked with to develop my own amendments, although I should note that the organisation itself takes a neutral position on the bill.
There have been some positive amendments—if not enough to make a substantial difference, from my perspective—and they were lodged in sincerity and good faith. There is now a requirement for the registered medical practitioner to set out in detail how they arrived at their decision to approve a request for an assisted death, rather than a simple declaratory statement to attest that the criteria have been met. That will aid transparency about decision making, but it will not improve the decision-making process in itself.
There are also now requirements to seek to identify indirect pressures and undue influence. That said, I was concerned by suggestions that coercion would not be a particular issue. I remain concerned about the ability to identify coercion, which can be hidden and tricky to recognise, particularly in relation to coercive and controlling behaviour.
I want to put on the record a quote from an article by Dr Anni Donaldson, Dr Mary Neal and Professor David Albert Jones in. They said:
“Given the scale of abuse, the low rates of disclosure, and the fact that training, however thorough, cannot reliably detect coercion, it is inevitable that coerced deaths will result if the Assisted Dying Bill becomes law.”
That is not a reason not to pass the bill, but we should not pretend that it will not happen.
There will now be a referral to a palliative care specialist by the registered medical practitioner if they believe that appropriate care is not being offered, but I am concerned about how the practitioner will always be able to have an informed view on that front. Indeed, more generally, we remain unclear about the skill set and training requirements of any practitioner.
It is of concern to me that the bill does not prevent any GP from raising assisted dying with a patient. My concern is that a GP raising such a measure would not be a neutral act, even if it was intended—I am sure that it would be—to be so. In some circumstances, it would compromise the doctor-patient relationship.
I am also aware of our Parliament having to remove protections for opt-outs and matters of conscience from those professionals who might otherwise be required to be involved in the delivery of assisted dying.
We all know about examples of excellent palliative care practice that can make a real difference for many. We also know that there are gaps and resource issues. Such provision is not consistent. We need a strategic expansion of palliative care services across Scotland, and we must build the budget to deliver that expansion in the next parliamentary session, irrespective of whether the bill is passed. For me, that would ideally happen before we consider assisted dying further.
We must also not conflate palliative care budgets with assisted dying budgets. I am not reassured that the bill does that appropriately. Assisted dying is not palliative care.
This evening, I will vote against allowing assisted dying. However, that does not stop me from being conflicted. My reasons, no matter how sincerely held, are likely to offer little comfort to many of those who wish to see assisted dying being allowed. We have heard powerful arguments. However, should the bill be passed, many people, particularly those who live with disabilities, will be deeply shaken.
I will finish with a quote from Inclusion Scotland, which brought the issue home to me. It said:
“Until disabled people have full access to supports necessary to live with dignity, legalising assisted dying will only exacerbate existing inequalities rather than expand genuine choice and control.”
I might be conflicted about the issue, but I am clear that offering choice for some will not offer meaningful choice for all.
19:27
It is on occasions such as these, when the matter that is under consideration is so challenged by complex ethical, moral, legal and practical questions, that I have come to know the Scottish Parliament at its best. We saw that last week and I believe that we are seeing it again this evening. That is because, for free votes, the increasingly confrontational and divisive politics of this chamber can be put to one side. Such votes encourage widespread respect across the debating chamber for different views, which are always sincerely held by the individuals concerned, and many are based on personal reflections. I again pay tribute to Liam McArthur for the respectful manner in which he has led the bill.
For many years, I have come to this debate conflicted, well understanding several of the key points raised by those who support assisted dying, partly based on my own family experience, but also understanding the key points in the case against. It is a debate in which I have become much more interested and, as such, I hope, better informed, given all the reading that I have undertaken on the subject and having listened to the many hundreds—perhaps many thousands—of constituents who have been in touch not just about this bill but about the two previous similar bills. I thank them all.
However, there are two particular aspects of the debate that continue to trouble me a great deal and which are the main reasons why I will vote against the bill this evening. The first relates to the protection of our most vulnerable constituents. I sympathise with all those who tell us that this debate is all about free will and the right to choose, but that free will and the right to choose can never exist in a vacuum. They are contingent on other factors: being free from pressure and free from any coercion.
Death, whether assisted or not, also affects the rights of other people. I make that point because that issue has been a substantial part of the concern of many within disability and other vulnerable groups, who believe that the bill would apply too much pressure on them. I share that concern. As MSPs, we often deal with very vulnerable constituents, and I have personally and professionally learned a great deal from that experience. As a result, I worry about the implications in relation to coercive situations within families, who may put pressure on vulnerable relatives to end their lives, perhaps for financial reasons in increasingly difficult fiscal situations or for reasons that suit their circumstances rather than those of the patient.
My second reason for opposing the bill is my on-going concern about the lack of safeguards and the hidden costs. Irrespective of whether members are for or against the principle, medical professionals are very clearly telling us that some aspects of the bill are both unsafe and unworkable because of the removal of section 18, which contained vital protections that, in their eyes, are central to the safe, ethical and fair delivery of care.
For me, society must surely always have a respect for the sanctity of life. That must include the medical profession’s commitment to saving lives. I continue to worry about a situation whereby we hand ultimate power to doctors, with the possibility that voluntary action could lead to involuntary action.
Then there is the issue of constantly improving medicine—the fact that, all the time, ever more successful treatments are being developed, including some treatments for diseases that were previously thought to be terminal. That is not unrelated to some of the arguments about the widening of the eligibility criteria, as has been the case in Canada.
I note, again, that the lead committee worried about the broad definition of “terminally ill”, believing that that could include those who might well live much longer.
As I have mentioned, the debate has always been complex and emotive, and it has deserved our fullest attention.
As I stand down from the Parliament in a few days’ time, I thank all colleagues, former and present, for their engagement with me over the past 20 years. However, I also express my earnest hope that, in future sessions, much more of our politics might be conducted in the current manner—considered, respectful and free from the unpleasant rancour that has come to colour far too much of our political discourse. I believe that the public both wants and has a right to expect that change if Scotland is to be a stronger nation.
19:32
I, too, thank Liam McArthur for the way in which he has engaged on the bill and with me.
Last week, we considered the specifics of what the bill would mean in real life. For 25 hours, we heard personal reflections and experiences as well as some of the difficulties in the detail. However, the question that got to me was, “When is it okay to bring up assisted dying with someone?” It got to me because it gets right to the heart of what we are debating. What sort of life leaves someone with no hope? What would we rather die than live with?
That question, and the bill, are hugely consequential. The bill will not only put sick and disabled people at a risk that cannot be mitigated in one bill or by one policy, including the risk from coercion, but will serve to reinforce the internalised ableism that we live with every day of our lives, and legitimise the view that a life such as ours—a life of dependence and, often, pain—is not for living. I cannot support that. No matter how hard or intolerable life can be for disabled people, there must always be the hope that we will have the right to practical assistance and support to live. If the bill passes, there is a risk that it will be easier to access help to die than help to live.
From fighting to go to the same nursery as my sister to delaying university for two years because I could not get a care package, and from fighting to be allowed to travel on the same bus as my husband to fighting to get a bathroom adapted so that I could have a shower, absolutely everything that I have has been a fight.
I even had to fight to keep overnight care so that I could go to the toilet, because the council said that it would be cheaper for me to lie in incontinence pads. That was the fight that nearly broke me. I was ill and crying every day, and the pain from my advanced-stage arthritis got worse because I was worn down fighting.
During the pandemic, my husband and I were so scared of other people’s power over our lives—lives that we could see others devaluing daily—that we wrote letters to each other making it clear that we wanted to be resuscitated.
I am one of the most empowered people in this country, and I have been broken by how hard it is to get the help that I need to live like the rest of you. When I have the support that I need and when I am not fighting I, and people like me, can live well: we can thrive. That is what the Parliament is for: we are here to legislate to empower everyone in this wonderful country to live well, including at the end. However, even when my pain is intolerable, it is the everyday ableism and discrimination that make me feel like I cannot go on. It is the lack of support, and the lack of options, that makes me feel like I cannot go on.
Disabled people do not have real choices in life. There will be countless disabled people in our constituencies tonight who have not had the choice to have a shower in weeks. There will be people who cannot choose when they go to bed and some who will already be in bed. There will be people who cannot choose what to eat and people who cannot choose to go out of the house because it is not accessible. There are people who cannot choose their care or the healthcare that they need, including at the end, because it is simply not available for them. Crucially, there will be disabled people whose struggle is so hard that they have given up hope and given up fighting, and will be considering taking their own lives.
I know that because I have been all the people I have described. They live in fear every single day, worrying about what new limit someone else will put on their life and what little power they will have to change it. They live every single day without choice at all.
It is inconceivable to suggest that the introduction of assisted dying is about choice when disabled people do not have choices in life. In a world where so many have little or no choice, we cannot risk making death the only choice that they ever have. If the bill passes, in a world of inequality it will be easier to access help to die than help to live. That is why I am asking colleagues to vote against the bill tonight.
I do not have much to lose when it comes to my body or my functions, and I, too, am scared of losing what I have, as others are—of course I am. However, I know that life can be good when we create a society where we have the support to live it, and live it well. Please, colleagues, vote against the bill, and choose to make it easier to live than to die, not the other way round.
19:38
I start my speech with the words of Kate Buchanan, who was a constituent of mine. Kate said:
“I don’t want to die, but I am going to … I want to be just like the rest of you—not thinking of dying all the time. But I can’t, it consumes me, it totally dominates my living, worrying about what is going to happen to me and my family. I want my children to not see me suffering, I want to mitigate that. And the only way I can see that happening is through this Bill passing. When you are debating this … think of me and think of my family … and all the other hundreds of families that are going through exactly the same thing. And do right, do right for Scotland.”
Kate died in October 2024.
Kate’s husband, Rodger, shared these words with me:
“My wife, Kate Buchanan, was an active supporter of the assisted dying bill. It has come too late for her to benefit. She found a lump in her breast in September 2023 and died in October 2024. She was fairly well until August 2024 and continued to have good days until mid-September. She was lucky enough to receive excellent care from Strathcarron hospice for the final five days of her life, where the staff were unfailingly kind and responsive. But even the best palliative medicine has its limits, and Kate knew that. It wasn’t the death that she wanted. Actually, she didn’t want to die. She loved life, but she knew she was going to die soon. She had stockpiled some medications to be able to take her own life, but, ultimately, we decided we didn’t have the knowledge to be sure of using them effectively and safely, and we didn’t want to put a friendly GP or a GP friend in a difficult or unlawful position by asking for advice.”
He went on:
“While Kate was an effective supporter of the assisted dying bill, she had a flaw as a campaigner. She was ill. She was dying. She wasn’t going to be able to see the campaign through to the end—something she shared with many other supporters of the bill. Kate was very conscious that this wasn’t a characteristic shared by many of the campaigners opposing the bill. And so that brings me to the point that she tried to make in her campaigning. That it is the task of you, as MSPs, to keep her and her fellow dying and dead supporters of the bill in mind; to represent, as elected lawmakers, those constituents who are no longer here; to put their point across and to have the courage to imagine having that difficult conversation with a loved one about how they wish to die, when it becomes apparent that death will come unavoidably soon.”
This bill has come too late for Kate, but it is not too late for us to vote for assisted dying and to give terminally ill people like Kate the death that they wished for. Remember Kate’s words and do right—do right for Scotland.
19:42
This is undoubtedly the most consequential decision that we will make in this session of Parliament, just five days before its conclusion. Indeed, it is one of the most consequential decisions that this Parliament has ever made in its relatively short existence. Many MSPs in the chamber will have made their final speech in the debate knowingly; we have heard about some of that already. Some in the chamber will make their final speech unknowingly. Some, of course, will return to the chamber to make speeches in coming years.
Nobody’s place in this Parliament and nothing that we do here is certain. As colleagues have already referred to, the only thing that is certain in life is death. Over these past days, weeks, months and years, we have debated what it is to die, what it is to have a good death, and how we support people in our society throughout their life and in its completion.
I want to begin, as I did at stage 1, by acknowledging the variance of views and experiences that have been shared with me by constituents and many others across the country—shared with genuine concern, passion and honesty. I will vote against the bill this evening, but I want people to know that I will do so with a genuine respect for those with whom I have found that I cannot agree, including Liam McArthur, the member in charge of the bill.
At stage 1, I set out my key concerns on coercion, and the deep concerns that disabled people have communicated to me in relation to the bill, not only during my time in Parliament but throughout my career working with people who have a learning disability and their families.
At stage 2, I followed growing concerns about the right of conscientious objection for healthcare professionals and organisations. As colleagues will know, in my amendments at stage 3 last week I sought to enhance protection from coercion, mandate training on it and provide an opt-out for organisations, particularly those with a faith ethos. I will dwell briefly on the failure of the latter amendment.
I cannot fathom why we would pass a bill that would not provide a sufficient safeguard and a right of conscience for organisations in this country that have provided care for hundreds of years. Those organisations and institutions are at the heart of our communities. Whether members have faith or not, they should recognise that those organisations and their staff have walked with, laughed and cried with, and held the hands and the hearts of people in our community in the darkest of moments. They cannot be allowed simply to be put into the annals of history. They have a place, they belong in our communities and they must be protected. My amendment that sought to protect them failed by only four votes, which was markedly different from the margin by which the general principles of the bill were agreed to at stage 1.
Of course, my opposition to the bill goes beyond just the amendments that were passed or not passed last week. I fundamentally believe that we do not debate the issue on a level playing field. We have heard a vast amount of testimony from disabled people about their fears of what would happen if the bill was passed. That is not imagined and it does not come from nowhere. It comes from the daily lived experience of disabled people and their families. In a country as rich, as democratic and as socially aware as ours, too many disabled people feel that they are not heard, not seen and not valued. They are our colleagues, our constituents, our neighbours and our friends. This is no longer a debate for the kitchen table, the pub or the radio. A monumental decision is before us, and we must hear their voices.
I come back to the comments that I opened with about certainty. Our time in this place will come and go, and the debates that we have, the victories that we mark and the disappointments that we experience will fade. However, the decision that we make tonight will be lasting and its impact will be wide. We must look disabled people in the eye and assure them that we can give them safety, dignity and protection—the things that they need to live their lives. I do not believe that we can do that. If there are colleagues tonight who, even now, at this hour, are unsure about that or any other aspect of the bill, they must join me and many others across the chamber at decision time and they must vote no.
19:47
At stage 1, I said that I supported the principles of the bill but not the specifics. I believe that the circumstances of our deaths should be as safe and compassionate as possible, but for too many people suffering prolonged and undignified deaths in Scotland, that is not because of a lack of effective palliative care. There is a total consensus in this Parliament on the need to improve Scotland’s palliative care services, but that is not enough for everyone at the end of their life. People still suffer over their final days and weeks, whether they effectively starve to death or lose their autonomy and the dignity that, for them, is rooted in that autonomy.
The first draft of the bill did not strike the right balance between affording the option to those who are at the end of their lives and giving sufficient protection to vulnerable individuals, but it is to the credit of Liam McArthur and a great many other people inside and outside this Parliament that the bill has been so significantly strengthened. Daniel Johnson secured the most important change—the requirement for the six-month prognosis. I recognise that that will disqualify some people who, perfectly legitimately in my view, and without any external pressure, wish an assisted death because of their illness, but it hugely reduces the risk of vulnerable people being coerced into something that they would not otherwise choose. It is not perfect, but it ensures that the system is only for those who are approaching the end of their life.
I am grateful to the Health, Social Care and Sport Committee for agreeing to my proposal for an advocacy service for any patient who wants it, and to all MSPs who supported the further changes last week to make that service stronger. The advocates would provide an essential service, helping patients to navigate the system and know their rights and options, and acting as an additional safeguard against coercion.
On top of that, the patient must have palliative care options presented to and discussed with them. In addition, the doctor must inquire about indirect pressures, including issues such as financial pressure, and they must discuss potential coercion.
The assessments by both the medical practitioners who are involved have been strengthened to include requirements for assessments to take place in person and by medics who have met the patient on more than one occasion. Thanks to Ruth Maguire, there is an additional structured assessment at the point of the second declaration that must take place in private. That is an important protection against coercion, particularly by partners or caregivers.
I am frustrated, though, that the very late concerns about legislative competence created so much uncertainty last week. We can be absolutely clear now that, if the bill is passed, it will not commence until arrangements are in place to ensure that no worker is ever required to participate in the process, that any worker who exercises their right not to do so is protected from any detriment as a result and that training and qualification requirements have been set for the professionals who are involved. That leads me to an important point.
This is the final vote on the principle of the bill, but, if it passes, it is not the final vote on whether a system commences. Once those provisions are in place to protect staff and to set training and qualification requirements, commencement regulations will be laid before this Parliament. If Parliament considers any of those to be inadequate, the commencement regulations can be rejected and the system will not start. The guidance that is necessary for the system to operate will also be subject to a resolution of this Parliament—a further safeguard and a further opportunity for Parliament to exercise its rightful control. I respect that that might not feel like a sufficient safeguard for some, but it is for me.
I will close by repeating what I said in the stage 1 debate. I sincerely believe that this is not an issue that should be decided by opinion polls. Organisations on both sides have shown that we can get whatever answer we want, depending on how the questions in polls are worded. The public have put their trust in us to make this decision on their behalf. It is the most important decision that I can imagine this Parliament making. For my part, I cannot reconcile myself with the prospect of denying those who face a life-ending illness the dignity of dying on their own terms. I will vote for the bill this evening.
I, too, thank Liam McArthur for the approach that he has taken in engaging with members across the chamber, on both sides of the debate. I do not think that there is anybody better suited—either in temperament or in manner of engagement—to have brought such a sensitive and complex bill to the chamber, and I sincerely thank him for that.
I echo Liz Smith’s comment that this debate, throughout its stages—1, 2 and 3—has been an exceptional demonstration of this Parliament at its best. It is perhaps cheeky of me to say this as I leave this Parliament, and as someone who has been an MSP for 15 years and was in Government for 12 and has never once voted against the whip, but perhaps less whipping in this Parliament might not be a bad thing after all.
In what is likely to be my final speech as an MSP—other members have said this—I cannot think of a more consequential piece of legislation to be speaking to. In 15 years in this Parliament, I, like so many of my colleagues, have cast hundreds, if not thousands, of votes. Day after day, we come to this chamber and, more often than not, we vote as instructed by that slip of paper that is handed to us by our whips. However, today, there is no party line—no whip. Today, every member must be guided not by a slip of paper, but by the weight of their own conscience.
My conscience tells me this: a society that leaves someone with a terminal diagnosis believing that their only options are either to endure intolerable suffering or to end their life prematurely has failed them. I refuse to accept that those are the only two choices available. There must be a third one—one that gives people comfort, relief and, yes, dignity in their death—without sending the message that ending their life is the only option available to them.
As someone who has taken a number of bills through this Parliament—and, dare I say, one or two that have even courted some controversy—I know how carefully we must think about the unintended consequences of legislation, especially legislation such as this bill, which is born of good intentions. Over the years we have corrected bad law, we have amended acts and we have even repealed acts. This bill is different, however. When the unintended consequences are death, there is no correcting it afterwards. No repeal can reverse it, and no secondary legislation can undo it. Death is final.
Even many of the bill’s strongest supporters have had to concede that there is no absolute, cast-iron safeguard against coercion. Coercion is not always loud. It is not always an overt threat. Sometimes it is quieter than that. Sometimes it is a look, a sigh, a hesitation, a sense that you are a burden, a feeling that your family would simply be better off without you. That is what troubles me the most.
That is not to say that those who argue passionately for the right to an assisted death do not have a case; of course they do. We would have to have a heart of stone not to be moved by some of the testimony that we have heard. I know that from personal experience. When my uncle died from pancreatic cancer, aged 54, I washed his body in preparation for his funeral, as is our Islamic custom. He had been a stocky man—5 foot 8 and 13 stone—before his diagnosis. By the time he died, he weighed just 6.5 stone. As I washed him, I could feel his bones protruding through his skin. When he died, I felt grief and heartache, but I also felt relief that he was no longer suffering.
I therefore say this with real empathy for those who are facing terminal illness, pain, fear and loss of dignity. If, in giving a small minority this option, we create a law under which even one person ends their life because they feel guilty, dependent or like a burden, then the Parliament will not have made compassionate law; it will have made dangerous law.
When disabled people’s organisations and domestic abuse organisations and experts warn us, and when those who know what it is like to live with dependency tell us that this law could expose people to pressure that they may never name as coercion, we should not just hear them—we should listen to them.
To colleagues who remain undecided tonight, I simply say this. If you are not absolutely certain that this bill can protect those most at risk, then do not pass it. If even one person chooses death, not from true autonomy but from quiet pressure, that is one person too many.
19:57
I believe that life is precious. I believe that life is a gift. I believe deeply that all life has inherent worth. That worth does not diminish with illness, with disability or with proximity to death. However, valuing life is not the same as insisting that life must be prolonged at all costs, in all circumstances, regardless of the suffering and regardless of the wishes of the person living it.
I believe in bodily autonomy. I believe in choice. I believe in the compassionate principle of being able to choose a good death. This debate has never been abstract for me. It is about family members, friends and constituents facing the end of their lives—in pain, in fear and, far too often, without the control, dignity or peace that they deserve.
Liam McArthur’s bill asks us a simple but profound question: do we trust people in the most difficult moments of their lives to make decisions about their own bodies, their own suffering and their own death? For me, the answer is resolutely yes.
People across Scotland have been talking about this question for years. Many are asking for honesty, for autonomy and for compassion. The majority of our constituents agree with the Humanist Society Scotland that
“This bill is about compassion, dignity, and the fundamental right to choose.”
We should be clear that the bill is not about abandoning care. Organisations such as Dignity in Dying remind us that good end-of-life care and assisted dying are not opposites but partners. They argue that everyone should have the right to plan and to control their own death, supported by robust safeguards and high-quality care. I agree. We must invest in palliative care—absolutely—but we must also recognise that even the best palliative care cannot relieve all suffering.
I have also listened carefully to people of faith. Quaker voices, in particular, speak powerfully of conscience, compassion and the importance of accompanying people with love at the end of life. Although there is not unanimity, many people of faith emphasise that moral agency and care must go hand in hand and that we must not turn away from suffering but respond to it with humanity and respect.
I have concerns about aspects of the bill, particularly the six-month prognosis requirement that was agreed last week. Prognostication is not an exact science. Clinicians have told us that predicting life expectancy can be deeply uncertain. By setting an arbitrary limit, we risk excluding people who are suffering unbearably but do not fit neatly into that timeframe. I believe that eligibility should be based on suffering and autonomy, not on a rigid estimate of time remaining.
In our deliberations, we have heard personal testimonies—a wealth of evidence on the lived realities of those at the end of life. We have also heard fears about coercion, vulnerability, the lack of decent palliative care and the message that the bill sends to disabled people. I take those concerns seriously, but I believe that the answer to them is not to deny choice altogether; it is to design care and safeguards that are strong, transparent and rooted in trust.
Right now, the absence of a legal framework does not mean the absence of assisted dying. It means inequality. It means that some people—those with means—travel abroad, while others take matters into their own hands, often in horrific, traumatic and lonely circumstances. That is not a compassionate status quo.
I come back to the people at the heart of this debate—those facing the end of their lives, who are asking not for the impossible, but for dignity, agency and peace. We cannot remove death, but we can shape how people meet it. I am very grateful to Liam McArthur for giving us the opportunity to shape our own deaths. Let us choose compassion. Let us choose dignity.
20:02
Like others, I recognise the incredible work that Liam McArthur has put into the bill in the last week, the last month and this entire parliamentary session. When I heard that an assisted dying bill was being introduced for a third time, before I knew the make-up of the Parliament this session and the views of individual members, I thought that it had the best possibility of passing this time because of the member in charge. Liam McArthur is the rare politician who it is very difficult to dislike. He works across the political spectrum and is compassionate, empathetic and absolutely committed to this cause. No matter how the vote goes tonight and no matter the fact that, less than two hours away from the vote, many of us are still unsure of how it will go, the fact that the bill has come this far is down to his efforts and the efforts of his team and of the non-Government bills unit. I want to put on the record, as someone who will not be supporting the bill, my complete admiration for what Liam McArthur has done to get this very passionate and difficult issue to the floor of the chamber and the way in which he has done it.
I will not be supporting the bill, but it has caused me more trouble than any other vote that I have taken part in. As Liam McArthur said when he was quoting Lisa Fleming, we have all had constituents—many hundreds or thousands—who have written to us about their personal experiences. They have been some of the most difficult and distressing emails and letters to read and respond to. You would have to have a heart of stone not to understand the pain and suffering that those constituents’ loved ones have gone through and how much they want to alleviate that for themselves or their loved ones in the future.
Others have spoken about their family connections, and I thought that George Adam, once again, spoke very passionately about his wife and his family. In my family, my wife takes a completely different view from me; she has always been very much in favour of the bill, and she cannot understand why I would not be. Therefore, this is an issue that splits not just parties; it splits families and couples, too, and there is no right answer. At the end of today, each and every one of us will cast a vote, and we will be able to defend it, one way or another.
For me, it all comes down to what is not in the bill. The fact that conscientious objections were taken out of the bill—for understandable reasons and because of the requirement for a section 104 order—concerns me. It also concerns the Royal College of Psychiatrists, which moved from a neutral position to a position of opposition to the bill, as well as the Royal Pharmaceutical Society, which similarly said that, because the bill did not contain vital protections for pharmacists and other healthcare professionals with conscientious objections, it could no longer remain neutral on the bill and urged members to vote against it.
Another issue that I have wrestled with a lot is that of coercion, which we have heard many members talk about tonight. If we cannot be absolutely certain—absolutely sure—that no one will feel coerced into taking their own life, because they feel a burden, or because of the efforts of others, we cannot support the bill.
I, too, fear that the bill cannot prevent coercion. We cannot legislate for human nature and human fallibility. Having changed my mind, and having decided to vote against assisted dying tonight, I wonder whether the member agrees that, if any member at this late stage is still in any doubt, the responsible thing for them to do would be to vote no.
I understand that members will still be in doubt at this late stage, despite all the debate that we have had, because this is such a difficult decision. However, as Humza Yousaf said in what I thought was an excellent speech, if just one person ends their life as a result of coercion, the bill will have failed. We will have failed as legislators, and this Parliament will have failed. We cannot allow that.
I will end by making two brief points. Liam McArthur has said before tonight, and others including Rona Mackay, Patrick Harvie and Alex Cole-Hamilton have said in the chamber this evening, that this bill is the most heavily safeguarded bill of its type anywhere in the world. That sounds really good and very comforting, but I see no way of assessing or judging that statement. I would love it to be true, but I am just not sure that we have the data, or the background, to support such a view.
Finally, there is another voice that I thought that we might have heard before in this debate, but we have not. As the enormity of this decision weighs heavily upon us all, I have been listening to experts. This morning, we had an intervention from someone whom I have respected for some time. Sir Harry Burns was this country’s chief medical officer from 2005 to 2014, and when he writes about the bill, as he has done this morning to urge MSPs to oppose it, we have to listen carefully to what he says. He said:
“We may have no medical cures for their physical illness, but we can and should give them a sense of control over their lives, not a pathway to death.”
I do not want to give people a pathway to death. If the bill, and the proceedings around it, have done anything, it is to ensure that not just Parliament in this session but Parliament in the next session and the next Government prioritise palliative and hospice care, so that we can ensure that people live their lives to the fullest opportunity for as long as they can, instead of giving them a pathway to death.
20:08
If one thing is clear, it is that the whole Parliament is united in—frankly, almost nauseating—tribute to Liam McArthur. However, the tribute is deserved. On a very personal level, and thinking back to our most recent conversation about the bill, I just wish that disagreeing with people was always so agreeable. That is a genuine personal tribute.
This is a bill that I have found difficult; indeed, I was opposed to the previous legislation that came before the Parliament. However, when I examined the matter from first principles and asked myself whether I would want to exercise this option if I were terminally ill, I concluded that I would. Should people have an option, and would they have autonomy? I think so.
However, I do not believe that people make decisions in isolation. They make decisions in the context of community, society and family.
Ultimately, when we legislate, we create expectations and norms. We create expectations of how people will behave in certain ways. Therefore, we have to ask ourselves whether we have the safeguards and protections that that needs, and we have to ask ourselves what kind of bill we have. I asked at the beginning of the stage 3 amendments, is this a permissive bill or is it a precautionary one? Is it one that enables people to do things, or does it provide people with an option in extenuating circumstances with safeguards?
Unfortunately, in my view, we have arrived at a bill that is the former. Yes, we have introduced many additional standards, considerations and procedures but, ultimately, what the bill boils down to is a decision that will be afforded to people on the basis of two medical practitioners’ judgments—yes, those judgments will be based on experience and training, but they will be the judgments of two people. That is why I think that the section 104 order is problematic. It is not because we will not have a say—we will—but the detail of that is so critical and we will not be able to scrutinise it or challenge it. We will be given a binary choice. Further, there is no external check on those two doctors’ judgments; there is no point of escalation and there is no oversight.
When we listen to the external royal colleges, we must listen to the detail. It is not only about the protections for conscientious objection. The Royal College of General Practitioners said in one of its principles that there is a lack of an independent and transparent system of oversight, monitoring and regulation. That is what the bill lacks.
A great number of members have said that the bill has more safeguards than any comparable piece of legislation. That is simply not true. If you look at the Australian legislation and at where such legislation has already been passed, you will see that virtually all of them have three external safeguards. Half of the Australian jurisdictions have a permit-based system, whereby every request has to be externally approved. Even in those that do not, every single Australian jurisdiction has two forms of external oversight, including a tribunal, by which individual requests can be escalated and assessed by the individual themselves, the medical practitioners or those who have immediate concern for the individual, such as family members. Each and every jurisdiction has an oversight board that oversees the implementation, assesses individual requests, can make referrals to other authorities, including the police, can provide advice to Government and provides on-going statutory review and recommendation.
We have neither of those oversight or safety mechanisms in the bill whatsoever. We have a narrow bill. It is true that we have increased the number of things that we are going to ask medical practitioners to take into consideration, but it ultimately boils down to two doctors’ opinions—doctors who can make mistakes or errors of judgment. They may make referrals, but no amount of referral will stop those errors or mistakes.
Very often when we legislate in this place, “good enough” is good enough. Legislation by necessity has to be a matter of compromise, but this is not an area where we can afford compromise—“good enough” is not good enough.
If members are seeking solace from the statements of members in the chamber that the bill has more safeguards than any comparable legislation, they are mistaken. If they do not believe that those safeguards are in place, they should not vote for the bill.
20:13
This will be my last speech in this chamber, and I am proud that it is in a debate on this bill—one where we are all free to be colleagues acting on behalf of our fellow Scots, regardless of our view or our vote at decision time.
I will begin my remarks by considering the philosophical tension that underpins the proposed legislation. On one side, the proposals before us can be seen as a continuation of the individualism that is now described as agency, and, in the context of this debate, the ability to make choices about the manner and timing of one’s own death. On the other side, we are reminded by philosophers such as Marcus Düwell that
“in the concept of human dignity questions about the role of humanity, the rights of individuals, and the structure of our normative social and political orders are interconnected.”
In essence, we confront a profound fault line between two fundamental considerations: respect for individual choice and autonomy, and recognition of human vulnerability and the state’s duty to protect life. However, we will not settle that philosophical dispute this evening—certainly not through the binary vote that each of us must cast.
During the stage 1 debate, I said that, whatever our vote, harms will occur. They occur already. Terminally ill people sometimes starve themselves to hasten death. Others are slowly overmedicated until life ends. We have heard multiple such examples from colleagues. That is our status quo.
My greatest concern during this process has been the risk of coercion. Members know my particular interest in the protection of women. That concern led me to support many of the safeguarding amendments, even in the knowledge that such amendments would make the bill more complex and, at times, more unwieldy. That said, coercion cuts both ways. I have heard first-hand evidence of families exerting significant pressure on their loved ones not to go through with their final wishes.
A further significant concern relates to the decision that key aspects of protection and regulation will now be handled through a section 104 order rather than via section 30. Even though section 104 orders are commonplace, like others, I remain unconvinced by the UK Government’s reasoning. It is a sober reminder that power devolved is power retained. I caution those who believe that, should the bill pass, the choice that they hope for will be immediately and seamlessly available. Politics will not end with tonight’s vote.
If part of our job is to pass good legislation—and it is—we must recognise that no bill is ever and can ever be perfect. This one is no exception. What we can say is that the member in charge of the bill has conducted this process with courtesy, respect and a genuinely open mind. I also commend the Scottish Government and, in particular, the Cabinet Secretary for Health and Social Care for the way in which they have handled this difficult terrain.
For my part, I will vote for the bill. It is not an unqualified vote. It is an on-balance, all-things-considered and, I hope, reflective yes. For those who remain uncertain, let me offer one final reflection. Yesterday, I visited my doctor and then my elderly father, I spoke to his carers and I talked to local constituents. I asked people informally what they thought. That was by no means rigorous research, but every person I spoke to expressed support. I believe that the public are ahead of us on this matter, and they look to us to create the progressive, dignified, supportive and enlightened Scotland that they seek.
Whatever the outcome this evening, the margin must be clear enough to give people confidence that the Parliament has reached a decisive conclusion. Therefore, I urge members who might be considering abstaining to vote one way or the other, so that we have the clearest indication that we can get of the will of the Parliament.
20:18
I, too, pay tribute to my friend Liam McArthur. I can only imagine the emotional toll that this process has taken on him. Whatever the result of tonight’s vote, he has done a brilliant job in highlighting the suffering that so many people are forced to go through at the end of their lives.
I was not planning to speak in today’s debate. I spoke in the stage 1 debate and thought that I had said everything that I wanted to say. However, I then thought that this would be my last chance to speak in a debate in this parliamentary session, and it might be my last chance to speak in the chamber for ever, as Paul O’Kane pointed out.
I could not look myself in the mirror if I did not do all that I could to try to get the bill approved. I did not take part in the discussions on stage 2 or stage 3 amendments, but I listened carefully to what everyone was saying. I must admit that I was saddened when listening to some of the debate last week. We heard a lot about doctors, nurses, lawyers, managers and social workers. At times, it felt as though we had forgotten what the bill is about. It is about people. The bill is about people suffering and what we could do to make their deaths as dignified and as pain-free as possible by giving them a choice when the end has come to reduce their suffering. We need to remember when we vote tonight that it is about the person who is suffering and giving them a choice.
Much has been said about palliative care. Of course we need palliative care, and of course we would all like it to be better, but palliative care is no magic wand. It is not like taking a couple of paracetamols to get rid of a headache. It does not remove all the pain and make everything all right. People should still have a choice when the pain becomes unbearable. It is certainly not an either/or when it comes to the bill.
Like many people here, I have got emotional over the bill. I have had conversations with those closest and dearest to me about the topic that no one likes to talk about, which is death. It is going to happen to us all and we should be able to talk about it, but it often seems too hard to do just that.
As I said at stage 1, I think I would never be able to have an assisted death. I think I would fight to have my last possible breath, but I cannot be sure. None of us here can be sure because none of us is suffering in the same way that some people are having to suffer right now.
We all have stories. My story is about a friend of mine caring for his mother at the end of her life. She was hooked up to morphine but begging her son to end her suffering. He will live with the guilt that he was not able to help his mother more when her pain was unbearable and all hope had gone. That is what we are putting people and their families through, but today we can change that.
As I said at the start, this might be the last time that I speak in here, but if it is, and if the bill passes, I will feel that I have achieved something in my time here. I will have played my part in reducing suffering. We have an opportunity to reduce the suffering that some are forced to go through at the end of life. I appeal to all colleagues who have not made up their minds. We have an opportunity to show what a compassionate place Scotland can be. We have an opportunity to reduce suffering at the end of life. We have all heard too many stories of people having a bad death. We have the opportunity today to make that better and to make a difference.
Assisted dying does not mean that more people die; it means that fewer people will suffer. Please do not let that opportunity pass us by. Let us not kick the can down the road for others to make that choice later on. Let us show that this Parliament works and truly represents the majority of people outside of here who support the bill.
20:23
Death is a universal experience, yet it remains a difficult subject. We all approach this debate with a profound desire to live. People who are asking us to support the bill would certainly rather live, but for many of them, that choice has been removed by a terminal diagnosis.
I think of my constituent Joanne and her father Robert, a retired firefighter. The unbearable reality of Robert’s terminal illness led him to beg his family to help him die. Too many families have been in that position. Too many people have experienced an agonising death against their wishes, yet it remains taboo—consigned to the too-difficult box.
I thank Liam McArthur for creating a respectful space for the stories of dying Scots and his immense capacity to listen. I also honour those who shared their most painful moments, so that others might not face a similar lack of choice. In a recent interview, I listened to Lorna Slater, who spoke movingly about her father’s beautiful death in Canada. I know that holding a loved one’s hand at the end is a sacred privilege, but for some, the law makes that peaceful holding of our loved ones impossible.
The Scottish Government has confirmed that the bill is within our legislative competence and is deliverable. We have vital clarity that commencement will only happen once employment protections and conscientious objection rights are in place, as well as requirements for training and qualifications.
The views of clinicians are important, but I was struck by the words of Rhona Baillie OBE—the chief executive of the Prince & Princess of Wales Hospice—in a letter to all of us, and I hope that all MSPs have had a chance to read her words. Rhona is a supporter of change, with more than 40 years’ nursing experience. She is advocating for a rights-based approach that is centred on the patient. I am heartened to hear that, should the bill be agreed to, her hospice is adequately prepared to engage with the new legal clinical framework.
I have seen the work of our hospice movement at first hand, even walking through fire for Kilbryde hospice. I say to those who argue that this is not the time because our systems are underfunded that they must join me in demanding that hospice-led palliative care no longer relies on bake sales and raffles.
Assisted dying is not a replacement for palliative care—it is additional. Our views on how healthcare should be in the future must not be used as a cover to deny individual choice today. Whatever our own beliefs and preferences, our decision must be transparent and honest. Vote on this bill, not on one that does not exist.
Our responsibility is not to judge but to provide a compassionate and safe choice for terminally ill people who want to have that choice. Voting for the status quo is not a neutral act. It will deny safeguards, hope and compassion to many. Tonight, I will vote yes for choice, agency and dignity for dying Scots.
20:27
My father chose to have a medically assisted death. He died on 6 November last year.
The process to access assisted dying was not straightforward. My mother, who was devastated by his decision but understood it, had to initiate the process and find the doctors and nurses with the right training. The service was not offered by the palliative care facility where he was, so she had to find people who were willing to attend from other facilities. Dad then had to go through all the interviews, the paperwork and the cooling-off period.
At each stage, the medical practitioners tried to dissuade him from proceeding. The reality is that only people as comfortable with administrative paperwork and as determined to work through complicated logistics—arranging multiple in-person meetings and so on—and setbacks as my well-educated middle-class parents could have made that happen.
When the doctor arrived, he gave what he called his “butter chicken speech”. He said, “Hello, Mr Slater. I see you’re here with your family. That’s lovely. We don’t have to do this today, Mr Slater. I can come back next week or next month. If you would even like to just have butter chicken with your family tonight, we can make sure that you can do that.” Dad had to energetically—and, to be honest, quite grumpily—insist that the procedure go ahead.
Dad was very ill. He was dying and had been moved to a palliative care facility a few months earlier when that became clear. He had excellent care. My mother spent hours with him every day, and he saw his grandkids regularly. He knew that he was not going to get better. He would never again be able to play Scrabble with my mother at the kitchen table or walk in the woods bird-watching as a citizen scientist—his favourite thing in the whole world. That was on top of the daily discomforts of tubes and injections, of being lifted and moved, of interventions and medical procedures, and of being rushed to hospital in the middle of the night when something went wrong.
My father was afraid that he would lose capacity and that the moment would come when he would lose the ability to make choices and understand what was happening to him. He knew that he was going to die and he wanted to do it in the bright light of day, surrounded by his family, while he knew who we were, before he could be incapacitated by pain or by pain medications. He was ready to go. He did not want to risk gasping out his last alone and afraid in the dark of the night.
My middle sister and I live a long way away from my parents, and his choice meant that he knew we would be there and that he would not die alone. It gave him the comfort of knowing that my mother would not have to cope alone, coming home from the hospital alone to an empty house.
Originally, only my mum was going to stay in the room during the procedure, but, as the nurse was getting things set up, my mum gestured for us to stay and the nurse said to me and my sisters, “Don’t feel like you have to leave. This isn’t going to be traumatic. Your dad will fall into the best and deepest sleep he’s ever had. He’ll probably even snore a bit,” and that is exactly what happened. Mum climbed into the bed to cuddle him, we girls held his hand, I got to hug him, and he told us that he loved us. He told us to look after my mum and he fell asleep—he did snore a bit. It was beautiful.
I wish that death for myself. I wish it for anyone who wants it for themselves. I do not mind if you would never want this choice for yourself but please, please do not prevent other people from choosing it for themselves. We should all have the right to choose.
20:32
I thank Lorna Slater for that speech—that was beautiful. I think that, tonight, we have heard some of the most profound and powerful speeches I have ever heard in this place, and I thank all members for that.
On a more positive note, friends, I celebrate another year alive this week, but I do so while also remembering those we have all loved and lost. It is bittersweet to end my time here discussing death. I voted to pass this bill at stage 1, like others, to let it run its course, and I have said little since. I think that we have done it justice. Half of the amendments that passed came from those who opposed the bill. I wish that we made more laws like this.
The debate ranged from fears of the worst of humanity on one side to well-meaning compassion on the other. I think that I sit somewhere in the middle, because there is always risk when making law. Our task is to weigh up that risk and mitigate it where we can. No bill is perfect, so the question we must ask ourselves is not an abstract one. If I or someone I love want that choice at the end, will it be there?
I want to speak plainly and from the heart, because I was deeply conflicted by this subject. Although every one of us will die, few of us will have a choice about the timing or manner of our death, and some argue that that is how it should be.
Truth be told, I do not want to die. I am afraid of it. After some recent ill health, I have spent many moments thinking about my own mortality. Will my death be quiet and peaceful, or accidental and sudden? Will it be painless or painful? In reality, our end-of-life choices are not always truly choices—do not resuscitate, nil by mouth, morphine, let nature take its course—but the one thing I cannot get out of my head is this: what if? What if palliative care can do nothing more for me? What if, in excruciating pain, I lose my dignity and control? What if I wish the end would come sooner and in a manner of my choosing? What if I would rather say my goodbyes with a smile on my face and perhaps a tear in my eye—not when I can neither see nor hear my loved ones? What if my body is spent but my mind is staunch and I decide that my time has come?
Regulated assisted dying already exists, but, disgracefully, only for those with the means to access it. Unregulated, unassisted dying exists by way of suicide, and that cannot be right. How is that in any way a choice?
I fear a painful death more than death itself, so the dilemma that I have grappled with is simple. God forbid the day ever comes when I need that choice, but would I rather it was there or not? Members must ask themselves the same question—there or not?
If I want that choice at the very end, I must offer that choice to others. I have no privilege in death. If we vote to deny people that choice tonight, we deny everyone that choice, including ourselves and including people out there who one day might need it—and who am I to deny someone that most final of decisions in life?
Dignity in death is not just a slogan—it is a right. When it comes to assisted dying, I believe, in my heart of hearts, that more people would be harmed by its absence than by its presence. If we vote against the bill and it falls, I believe that I would wake up tomorrow and regret it, and I think that others in the chamber might, too. I could not look someone in their eyes in their dying days and tell them that I denied them that choice.
I will sum up in the words of Diane, who wrote to us all on Saturday afternoon. She simply says this:
“It is better to have it and not need it than to need it and not have it. It is my body, my life and my death. Only I will know when enough is enough. Please grant me the choice to fulfil my dying wish .”
I say to Diane that, tonight, I will do just that. I make this plea to others: it is not too late to change your mind. No one will judge you for that. Vote to give me that choice. Vote to give yourselves that choice. Vote to give everyone that choice.
20:37
I start by sharing my respect for Liam McArthur; I find him to be a good parliamentarian and a good man. However, I must also say that it remains a fact that consent, choice, free will and autonomy are not being experienced equally by all. My fear remains that, for the estimated one in three women who are living with domestic abuse, the bill, even with the modest amendments that have been made around coercion, could become another lethal tool to be wielded by an abusive partner. The danger is real. The deadly consequences for those women would be final.
I normally relish debate, even when it looks like I am going to lose, but today I feel really uncomfortable. This legislation frightens me, and I am not someone who scares easily. I did not get into politics to talk about myself and my own feelings; this is certainly not a natural space for me to be in, arguing against something that I am fearful of rather than for something that I believe will bring about a positive change or protect people.
In what will be my last speech in the Parliament, I am a little sad that my final contribution shares fear and not hope, but I am scared that, if the bill passes because of the perceived positive impact on the small number of people who wish to end their lives early, the negative and equally impactful experiences for many others and for our society as a whole will be immeasurable, and they will not be something that we can come back from.
As well as the casework that I receive from citizens who are not currently having their needs met by the health and social care services, I have direct experience of living with a diagnosis that will not be cured. My life will be shortened—I do not like saying that out loud, especially in front of you lot, but it is a fact.
I find it really hard to put into words the impact that the language of dignity and compassion being used to talk about ending life has had on me, as if, somehow, wishing to carry on but with help is undignified and burdensome and unfair to people who love me—and that is just in the context of us talking about it in Parliament. My blood runs cold thinking about sitting in a room in a hospital and having a doctor raise that with me as we weigh up treatment options.
I share that thought in the full knowledge that people in my situation are not a homogeneous group and because I want colleagues to consider, if it weighs so heavily on me, as someone in a position of financial privilege with a large, loving family who are able to care for each other—indeed, as someone whose job it has been for 10 years to have difficult conversations and debates and to have my views and beliefs challenged—how this all plays out for people who do not have the privilege that we have.
In considering that, let us have our eyes open to the strain that our health and social care systems are under. Not everyone is receiving the care that they need. If the bill is passed, it will be funded from existing stretched budgets. What healthcare will we stop to fund this? Are we really going to be a country where the state funds dying while hospice care relies on charity? Consent, choice, free will and autonomy are not experienced equally by all. It is not a free choice if someone does not have access to good palliative care, it is not a free choice if someone has no family to support them and they are lonely and isolated, and it is not a free choice if they are grappling with poverty or other forms of inequality.
If the bill is passed, institutions will not be able to make a choice to opt out, meaning that some valued hospices and care homes will close at a time when we really need them, and doctors will not have a choice to opt out. It is a fact that those protections have been stripped out of the bill. There are no guarantees on what they will look like, and this Parliament will not be able to scrutinise or amend them.
In voting against the bill today, I am just choosing to vote for the inherent dignity of life, and I urge colleagues to do the same.
20:42
This evening’s debate has been deeply emotional. Many members have spoken about the deaths of loved ones and how those experiences have shaped their views on assisted dying. I begin by acknowledging that sincerity. None of us comes to the issue lightly, and I do not question the compassion or integrity of those who will vote differently from me this evening.
When I entered Parliament, I instinctively shared many of the same instincts that lead people to support the principle of assisted dying. Two motivations have come through clearly from members across the chamber. The first is the desire to reduce unnecessary suffering and the second is the desire to respect and protect individual autonomy. Those are humane values, and they are values that we all share. They are not the dividing line in this debate. The real question that is before us tonight is whether those principles can be translated safely into the bill that sits in front of us. Having studied the safeguards that are proposed in the bill and listened closely to the debates throughout its passage, I have come to the conclusion that the bill does not provide that certainty.
My greatest concern is the risk of coercion. Amendments have been made in good faith to strengthen the safeguards, and I recognise the effort that colleagues have put in to that work, but I remain unconvinced that coercion can be reliably detected in every case. Experts have highlighted how subtle and deeply embedded that pressure can be. In situations of domestic abuse, for example, people often come to see the world through the perspective of the person who is exerting control over them. They may not recognise that pressure until they have had the time and space to reflect on their circumstances. The process set out in the bill does not allow for that depth of reflection. In legislation of such gravity, where the consequence is irreversible, even a small risk must weigh heavily on us.
I have been troubled by the reliance on the section 104 order to determine key safeguards and by matters such as conscientious objection, and the training and qualifications required of medical professionals. Those are not technical or minor details; they are fundamental protections. Yet we are being asked to pass legislation knowing that those aspects and safeguards will be developed later through secondary legislation, subject to limited scrutiny and not shaped directly by the Parliament.
We are legislating in one of the most sensitive areas of human life. Any uncertainty about how core safeguards will ultimately be defined is a serious concern. Throughout stages 2 and 3, I proposed amendments that were intended to strengthen the bill. Those debates did not provide reassurance for me—they confirmed that important gaps remain.
I also remain concerned about how an assisted dying service would sit within the NHS. If such a service were ever legalised, it must never become an expectation placed on patients or clinicians, yet the structure of the bill risks embedding it as a normal part of NHS provision.
I received a letter from 370 healthcare professionals across Scotland. There were many familiar names in that document, including those of clinicians that I have worked with for decades, ex-presidents of the royal colleges in Glasgow and Edinburgh, and consultants and medical directors from Aberdeen to Wishaw.
As we reach the end of this long and emotional debate, there are simple questions that we must ask ourselves before we vote. Can coercion always be detected? Are the safeguards fully defined and determined by the Parliament? Will the legislation avoid fundamentally changing expectations in the NHS? Ultimately, the doctor-patient relationship will change for ever. If we cannot answer those questions with a yes, with complete confidence, our responsibility as members of the Scottish Parliament is clear. We must vote no.
20:47
First, I acknowledge every person who has taken the time to contact me to set out their views on the bill. Without doubt, this bill has generated more correspondence than anything else that I have dealt with in the 12 years that I have been an MSP: several thousand constituents have contacted me to set out their views. As I said in the stage 1 debate, some of the experiences that people have shared with me were heartbreaking. I understand with sincerity the strong views and beliefs, and the legitimacy of the arguments on both sides of the debate.
For me, the questions around access to quality palliative care are crucial to the debate and to my decision making. The proposer of the bill has said time and again that it is not one or the other, that access to quality palliative care should sit alongside access to assisted dying and that people should have that choice. However, we know that that is not currently the case: if the bill were to be passed tonight, people dying would have access to assisted dying but would continue not to have access to quality palliative care. They would be in a position whereby they can be supported to choose death but they would not be supported to choose life.
Only four weeks ago, I raised a question in the Parliament on the report published by Marie Curie showing that one in three people in Scotland die with unmet palliative care needs. I am sure that we would all agree that that is an unacceptable situation but, for me, it is fundamental to the question that we are debating. I say again that if you are dying and you are not able to access the support and care that you need, but you are able to access an assisted death, you are being denied the choice of life. That cannot be right and it is not right.
There are many other unanswered questions over the bill, but one that I will highlight is the cost of delivering it, which is unknown. The Scottish Government says that a degree of reprioritisation will be required. In other words, members are being asked to support a bill over the implementation and cost of which there are many uncertainties; nevertheless, we are being warned that other services will be cut to fund it. Surely, that is not right.
I found myself struggling throughout the debate on amendments at stage 3, because legitimate arguments are being made on both sides of the debate. I kept asking myself what I would want at the end of life. Would I want to be able to make the choice of an assisted death? However, I kept coming back to the first principle, which is that I would want to be able to exercise the choice of accessing the support of quality palliative care. If that choice is not available, there is no choice.
We have the power, ability and resource to prioritise palliative care and make Scotland a world leader. For the reasons that I have stated, I believe that that should be our priority, and I will vote against the bill tonight.
20:51
I, too, thank Liam McArthur, from the bottom of my heart, for enabling and empowering us to debate a very important issue.
I clearly recall staring for a full five minutes last June at a message from my best friend as the world around me fell away. It was a message of four small words with mammoth implications: “She has called it.”
I had known Madame Bergeron from the age of 19. She was the epitome of a classy French chic woman—always immaculately turned out, slightly aloof and sarcastic, and oh so determined. She terrified me and awed me in equal measure. She had pioneering heart surgery when both her kids were still teenagers, and she lived her whole life disabled, yet she commanded every room that she ever entered. She was not always easy to live with, but she was loved fiercely by all those around her.
She had been living with terminal cancer for more than three years, and it had consumed her entire abdomen. That day in June, she had sat down heavily in her wheelchair and felt something burst inside her very distended stomach. At that moment, she knew that she would develop full-blown peritonitis and sepsis and would require all kinds of pain medications and sedation to try to manage her symptoms, in a hospital setting, before succumbing within the week.
That was, categorically, not the path that she wanted. She had lived with the very best of palliative care and, for most of those three years, the palliative effect of the ability to have an assisted death. She called that her security blanket. It had given her great comfort as she chose to live for as long as she could, with grace and courage.
She was anything but suicidal. A Catholic of strong faith in the Quebec Roman Catholic tradition, she said that she knew that her God was merciful and that she had the support of her priest and her community when she set in train the plans that would help her to leave this world on her terms, as she had lived her whole life.
Nathalie dropped everything to drive the three hours from Montreal to Shawinigan, where the family gathered for one last evening. There were tears and there were laughs—and, boy, were there commands. Madame Bergeron was conducting like a symphony master. She wanted everything to be just so. Nathalie recounted to me that she could not help but be frustrated at her mum’s painstaking choice over her final pyjamas and dressing gown, until she realised that her beloved maman was dying as she lived—elegant and oh so bossy.
The house was full on the afternoon that Nicole Bergeron died, peacefully dressed in white daisies. Her bed was surrounded by loved ones, who shared the most tender of moments. She was able to speak to each of them, and the words that she spoke to my best friend were the salve that has helped Nathalie to come to terms with her loss. Nathalie has also described her mother’s death as beautiful. Madame Bergeron, tu me manques énormément.
Please contrast Madame Bergeron’s passing with the way in which my mum, Irene, died, 12 years ago this week, after more than two weeks without food or water. She was surrounded by love, absolutely. She had also been assessed as having capacity and as making her choice free from coercion, but she did not have a peaceful death. She took the only legal option that was open to her under our current laws—and it was awful. I do not have the words to describe to members how awful it was, Presiding Officer. If you have not seen somebody starve to death, there are no words to describe it. She deserved better.
My decade at Scottish Women’s Aid taught me how real coercion can be, but it also taught me that the answer to risk is not to look away from difficult situations. I spent time training police officers, social workers and housing staff about coercive control before this place had even named it and recognised it. With the right skills, training and opportunity, it can be detected. To say otherwise is simply to walk away from a wicked issue.
Right now, behind closed doors across this country, women with terminal illnesses who are experiencing domestic abuse have no safeguards. The bill would help to bring that coercion into the light, to remove the power from abusive men and to return that agency to its rightful owner. That is what the bill is about—agency and autonomy. We must give our folk choice. It is, after all, the settled will of the majority of our constituents, including those who are disabled and those who have experienced domestic abuse, especially those who are terminally ill. They are forgotten in all these conversations. They are our most vulnerable citizens. Please vote yes for them.
20:56
On a topic on which many members are either vehemently opposed or passionately supportive, we have seen both sides seek to have a genuine, constructive and respectful debate on the substance of the bill. I commend colleagues across the chamber on both sides of that debate. I make special mention of Liam McArthur and his team for their efforts in introducing the bill. I also want to highlight the fact that members and their staff have worked incredibly hard to make the debate worthy of such a significant issue.
There are those who are vehemently against the bill and there are those who strongly support it. I absolutely respect our colleagues’ right to their positions. It strikes me that, after 10 years in this place, where I consider some of our interactions and some debates to have been less than ideal political discourse, we are finally getting to show what this Parliament really can be.
At stage 1, I voted for the principles of the bill. I did so because my instinct is to allow choice, even though the choice of an assisted death is not one that I can ever imagine making for myself. I recognise that, thankfully, I have never been in that position. The fact that it is not a choice that we, as individuals, would make or believe in does not mean that we should automatically take that choice away from others.
However, it is, of course, not black and white. I had serious reservations about the bill as drafted, and I said that it would have to be significantly amended. I remain concerned about the exclusion of pharmacists from the healthcare framework, despite their expertise in the supply, handling and effects of medicines and other drugs, and the lack of safeguards for other healthcare professionals.
Similarly, there are concerns about the risk of coercion, especially in the amendments that allow for doctors to raise the subject of assisted dying with patients at their discretion. The doctor-patient relationship involves a profound degree of trust. To my mind, a doctor proposing assisted dying to a patient as an option could compromise that trust and risk the patient feeling pressurised towards a choice that they may not otherwise make.
The bill has shone a much-needed light on palliative care, social care and general access to medical care. It is not about other care provision, but assisted dying cannot be seen in isolation. I mentioned giving choice to people, but it must be a real choice. It must be a choice that includes appropriate palliative care, social care and medical care. Without those elements of care, it is no choice at all.
I hear that East Ayrshire Council is reporting a £10 million deficit in its social care budget, which will inevitably result in cuts to services. I hear that North Ayrshire Council is delivering critical care only. Only yesterday, on a visit to care services, I was told of a couple who are having their care package cut, and they are now waiting for the outcome of this bill. That is being replicated across Scotland.
Many members have talked about their own experiences. I have not done that yet, but tonight I will. My aunt recently died of stomach cancer. In the middle of the night, she was on her hands and knees in agony, waiting for pain relief to arrive. However, she eventually accessed palliative care, which gave her a much more comfortable last week or so and a much better experience for her and the family.
Too often, we have heard that appropriate end-of-life care is not accessible, be that palliative care, social care or general care. As the need increases, cuts are being made. Shame on us. It has to be better than that.
I know that, whatever way we vote today, we will be seriously letting down a huge swathe of the public. My decision comes down to having evaluated everything that I have heard in evidence, in the debate on amendments, both in the chamber and in committee, and through my community. I have come to the conclusion that there is no right answer here.
I began my speech by saying that I believe instinctively in choice, but it must be real choice. I have come to the conclusion that, if I have any doubts, I cannot vote for the bill. At the end of life, we should have the option of choosing how we depart this planet on our own terms. Unfortunately, to my deep regret, I do not think that the bill, in the current social climate, meets the high bar that is required to pass assisted dying legislation. Given those concerns, I cannot, in all conscience, vote for the bill.
21:02
As I said last week during consideration of stage 3 amendments, and as others have repeated this evening, this is the most consequential bill of this parliamentary session, and it is probably the most consequential bill of the devolution era.
Although I will vote against the bill at decision time, I want to join everybody across the chamber in commending Liam McArthur for his approach, his openness with colleagues, irrespective of political persuasion, and his engagement with lots of professional organisations and families who have experienced difficult deaths. His approach has been second to none.
This is the third vote on assisted dying that I have participated in. The two previous bills, which were brought by Margo MacDonald and Patrick Harvie, were wide in scope, with few safeguards, leaving the door open to unintended consequences. As a result, clinicians at the time opposed the legislation, and both bills failed at stage 1 by a considerable margin. By contrast, this bill has taken a much narrower approach, and many medical and palliative care bodies have remained neutral as a result.
Since the bill was first proposed, I have heard very moving stories from those who believe that assisted dying could have prevented unnecessary suffering and from those who want agency at the end of life. I have also listened to the concerns of disabled people and those who fear that assisted dying could have led to a loved one’s unnecessary death. I cannot do justice to their testimony in four minutes, but their stories stay with us all.
We have considered the role of doctors and nurses, the definition of a terminal illness, the risk of coercive control and much more besides. However, there is no decision on the model that would be used, and there is no certainty about the cost to the NHS for the implementation of this bill. All of that is taking place against a backdrop of financial pressures on palliative care, leaving us with the uncomfortable question of whether terminally ill patients will be able to make a choice at all. I will not rehearse many of the arguments that have been put, but I agree with all of Bob Doris’ comments about palliative care and Brian Whittle’s comments about the real crisis in social care just now.
In dealing with the bill, I worked with Hospice UK, Children’s Hospices Across Scotland—otherwise known as CHAS—the Royal College of Nursing and the Royal College of Psychiatrists to improve the safeguards in the bill. Some of my amendments were accepted, and I thank colleagues for that. I recognise that there has been progress from where the bill started.
There is a fundamental problem with the bill, however. The Scottish Government rightly advised that the employment issues covered by the bill were not legislatively competent, so the bill can become law only with a section 104 agreement between the Scottish and UK Governments. Provisions allowing protection for staff were therefore completely removed from the bill last week, with the promise that they will be put back in after the bill has passed. That was a watershed moment for many members. The UK Government has taken a position of neutrality that mirrors that of the Scottish Government, but I was genuinely concerned that the cabinet secretary could not guarantee to me, when I questioned him, that all the safeguarding provisions would be replicated through a section 104 agreement. For many MSPs, that was the equivalent of asking them to vote in the dark—and for that to come so late in the day was problematic.
There are questions about whether the bill was competent even on introduction. Consequently, it came as no surprise that the Royal College of Psychiatrists changed its view from being neutral to opposing the bill, as did the Royal Pharmaceutical Society in Scotland. Many of us have received emails from clinicians expressing significant concern on that point.
We have all been weighing up the views of constituents: the views of those who will have to implement the bill if it is passed and the views of families who have lost loved ones in difficult circumstances. In all this, our job is to consider the impact of the bill. That is unemotional; it is about analysis. In doing that, I have come to the conclusion—regretfully—that I cannot support the bill as it stands.
21:07
Like others have done, I will mention the point made by Liz Smith about the excellent nature of the debate that we have had. However, she mentioned something else, which has not been repeated but which I think is worth repeating. I have always thought that it is perfectly possible for this Parliament to have debates of this quality, but we just choose not to do it. The other point that Liz Smith made about the need to get past the rancour and bad humour that is too evident in the chamber too often is extremely important, and I hope that that view prevails in the next session of Parliament.
The approach that I have taken to the bill has very much been to maximise, where I thought I could, the safeguards that were presented through the amendments that would apply in the event that the bill passed, but not to the extent that I thought that they would make the bill unworkable if it did pass.
There are two issues for me, like for many other members. First, there is the section 104 process, which is a huge issue. No one in this Parliament will draft the section 104 order; it will be drafted by others. It is then due to go through a process in which this Parliament will have no say, and it may be rejected completely. To those who say—rightly, I think—that this is one of the most important bills that we have ever considered, I say how can they accept that we will not see two vital areas of legislation through to their conclusion because the decision will be taken by others? I cannot accept that. I do not trust the idea that another Parliament can be trusted, and not because of any malevolence on its part—I think that is evading responsibility.
My main concern has always been in relation to the issue of coercion and especially the pressure that people will put on themselves. When I think about this, I usually have in my mind the picture of a woman—usually a mother. In the past few years, I have lost a niece, a sister, a mother and a partner in similar circumstances, all of whom were mothers. This might be a misogynistic view, and it might be patronising, but my view is that mothers in particular feel much more keenly than the general population the need to relieve burdens on others. It is almost socially instilled and, if it is not, it comes through sheer love—a word that has not been mentioned much in the debate until this point.
I was very touched by Lorna Slater’s speech. It is of course true to say that this is also possible for men, but it may be a matter of a mother, in particular, deciding, for example, that her remaining family would be better off financially if she was to decide to go for assisted dying, or that it would be easier for some of her children—in my case, sisters having to travel from Wales and England to come and see her on a regular basis—were she to choose assisted dying. I know that there will not be many cases like that, but, like Humza Yousaf, I would say that one is too many.
It is also important to say—as Michelle Thomson did, although doing so has not been prevalent—that there is pain on both sides. I acknowledge that people will still have to go through some of the terrible experiences that they have to go through currently if we do not pass the bill, but those who are urging that we pass it should also acknowledge that, if it does pass, there will be pain on the other side. Members can imagine that, if their mother, sister or somebody else they know decided to go for assisted dying for reasons other than the ones that have been proposed, because they felt that in that way they would be less of a burden, there would be pain on that side, as well. Both of those experiences are extremely valid.
It is also true to say, as Ruth Maguire did, that the issue of domestic violence and the fact that women can be made to feel that they have no worth are extremely important in all of this.
I was extremely moved by Pam Duncan-Glancy’s speech. It brought home to me, in a way that had not been done previously, the idea that a lot of disabled people probably cling to and take a huge deal of comfort from the fact that assisted dying is not currently in law. That is worth thinking about.
In my view, two of those issues are crucial. One is the section 104 issue, which is about the inability of the Scottish Parliament to see through some of the bill’s most crucial provisions, or even to be absolutely assured that they will be seen through. I remind members that I told them during stage 3 that a GP had come to see me and said that she would resign immediately if any bill was passed that took away the right to conscientious objection. The other crucial issue is coercion. Explicit coercion is a true concern, but more pressing for me is the idea of self-imposed coercion. I do not think that the second of those issues can ever be successfully dealt with, although the first one perhaps could be.
In conclusion, I think that a law on assisted dying will come at some point. I just do not think that this bill is the bill that we should pass.
21:11
One of my colleagues suggested to me that he would rather that religious people be up front and say that they oppose the bill because of their belief in God. As that is one of my reasons, I am happy to say a little from that angle. However, I have other reasons for opposing the bill, including reasons from a financial perspective, given my background as an accountant.
On the financial front, when we debated amendments to the bill last week, Michael Marra questioned whether the financial memorandum fully covered the estimated costs. However, another angle that relates to finances is whether there is an opportunity to save money if someone chooses an early death. It seems to me that the public purse has the potential to save on hospital places, on care home fees, on pensions and, perhaps, on other costs if assisted dying becomes an option.
Clearly, if someone chose to die just a few days before their natural death, that would not make much difference to cost. However, if someone had a life expectancy of six months but could perhaps go on for a year, the savings could be considerable. That is not to mention the fact that, for a family who have a well-off elderly relative, getting their hands on the estate more speedily could be very attractive. We know that power of attorney is abused by some families and that it is not well policed. Therefore, it seems likely that a range of players could potentially benefit financially if assisted dying became an option.
That is why last week I deliberately chose to talk about “encouraging” rather than just “allowing” an early death, which was the phrasing that Lorna Slater objected to. Sure, we are talking right now about giving people more choice—of empowering them and using words such as that. However, we need to look further ahead at what could happen and at what—I think—is likely to happen.
We have discussed how difficult it is to stop coercion or pressure on someone to end their life prematurely, especially when that pressure could be very subtle. How much more could that be the case when financial incentives are added in?
What about the angle from a Christian perspective? At its core, our belief is that God gives life and God decides when life should end. Clearly, there are also human reasons for both birth and death, but we believe that, behind all that, God is guiding and directing. I should say, to be fair, that not all Christian believers oppose assisted dying; just on Sunday, one of my friends at church told me that he supports it.
What about the question of suffering? Surely a loving God would not allow suffering, would he? That is a question that folk often ask and have asked for many years of people of faith. There is not exactly an easy answer to that question, but, yes, actually, God does allow suffering.
We believe that, because human beings chose to go their own way rather than following God’s way, suffering came into what God had made to be a perfect world. Suffering is happening all over the world, and there can be suffering with a natural death and with an assisted death. We all want to reduce suffering as much as we can, whether we have religious belief or not, so I absolutely support the many calls for better palliative care and encourage the provision of more resources for the hospice movement, as others have said.
At the end of the day, no one really wants declining health or a death, yet they are part of the human condition. One big difference for those of us with a Christian belief is that we are promised life after death, so however hard our lives might have been—and, for that matter, however hard our deaths might have been—there is something better available to look forward to.
Perhaps not surprisingly, I am currently reading a book about retirement, and it makes the point that older people have so much to offer. We all have so much to learn from people who are older than us and also to give to people who are younger than us. So, please, colleagues, let us not undermine the older people, their value and what they still have to contribute. They are valuable, and I think that we are duty bound to oppose this bill.
21:16
The years of hard work and dedication of Liam McArthur and, before him, Margo MacDonald and Patrick Harvie have taken this Parliament to a definitive moment. Rona Mackay, Alex Cole-Hamilton, Sandesh Gulhane, Carol Mochan, Lorna Slater and many others have made thought-provoking and moving contributions. Like them, I back choice for anyone of sound mind who is stricken by eternal illness and the loss of bodily functions, of autonomy and of basic human dignity.
Of course, we already have assisted dying, for people who have money. Up until the end of 2024, 608 UK citizens had ended their lives at Dignitas in Switzerland, at a cost of £7,000 to £14,000 each. Those deaths often happened earlier than necessary because of the need to be able to travel.
At stage 1 of the bill, I mentioned a West Kilbride constituent who suffered from progressive supranuclear palsy, which is a horrific neurodegenerative terminal disease. In August, she ended her life in Switzerland. In reality, we have a two-tier system with assisted dying only for those who can afford it and the status quo for everyone else.
We must recognise that, across the UK, 300 to 650 terminally ill people take their own lives in despair each year, denied an assisted dying safe death. Desperate people watching a loved one die in agony sometimes risk prosecution and incarceration by ending the life of a terminally ill loved one. Palliative care does not always alleviate insufferable pain. A regulated system, backed by legislation, must be better than the status quo.
Dr Julian Neal, a retired GP, said:
“To deny patients the choice of an assisted death when we know that a significant minority of deaths are wretched, no matter how expert the provision of palliative care, seems to me utterly wrong. But this is what I was forced to do when asked for help to die by a patient with advanced metastatic melanoma. He was intelligent and knowledgeable about what lay ahead, wanting to avoid a lingering demise. I explained that I was unable to help him due to the very real threat of imprisonment. I was later horrified to learn that he had shot himself.
An assisted dying law would provide a kinder, safer alternative which I and a growing number of doctors would be prepared to be involved in; a welcome and much-needed change from the cruelty of our current system.”
Zoe, who is not a constituent, said:
“By the end, my mother’s cancer had spread … all the way to her brain and she was in terrible pain. Mum was determined not to let the cancer do its worst; that she would construct some kind of escape. Because she had no other viable alternative, she attempted to take her life out in the garden, alone.
When we discovered her she was still breathing, and as it began to grow cold I rang an ambulance to help move her inside. I told them of Mum’s clearly defined wish not to be revived and showed them the legally-binding documents to prove it, but they would not listen. A doctor … threatened me and called the police. Paramedics, doctors and police officers were all in my garden arguing about what to do, as my Mum lay dying on the ground.
Hours later Mum regained consciousness and was in emotional and physical agony. She had written heartfelt notes to us, which the police confiscated. A few weeks later, Mum did finally manage to escape her pain. I was questioned by police for hours and made to sign a five page statement. Then she was subjected to an autopsy; the final insult.
Eleven months later my husband Andrew was diagnosed with colon cancer. His death this year was full of horror, pain and indignity; we crossed every line we didn’t want to cross. I cannot put into words how different it would have been for them and for our family if my Mum and my husband could each have been assisted to go peacefully as they wished, and with the dignity they deserved.”
Supporting the bill is about compassion, personal choice and human dignity. For the many like Zoe, please support the bill.
21:20
I am sure that this must be one of the most serious and thoughtful debates that the Parliament has ever undertaken. I begin by acknowledging the sincerity of colleagues across the chamber. I have been moved by speeches from members on both sides of the issue.
Members who support the bill do so out of compassion for those who are suffering. Members who oppose it do so out of concern for the vulnerable and for the principles that guide medicine. No one approaches such a decision lightly.
For me, this is not an abstract question. Like many people, I have been at the side of those I love as their lives have come to an end. I watched my parents die. I watched my wife’s mother die. I have watched dear friends and family pass from this world. Some of those deaths were peaceful; some were harder. Those experiences stay with us. They remind us of something simple but profound: death is part of life. It comes to us all. Experiences like that shape how we think about questions like this. They remind us that death is not simply a matter of policy or law. It is deeply personal. It touches every family.
However, the decision before the Parliament today is not about abstract principles. It is about the legislation that is in front of us. It is about whether the bill represents sound and safe law. I have come to the conclusion that it does not.
During the bill’s passage, we have heard increasingly serious concerns from those who would be responsible for its operation in practice. There have been letters from hundreds of doctors and nurses, including the one that Sue Webber quoted earlier, warning us that, in their professional judgment, the bill does not contain sufficiently strong safeguards to protect patients from coercion, untreated mental illness or unmet social and palliative care needs. One signatory of one such letter put it plainly, saying that this is not a theoretical debate; it concerns the safety of real patients.
We have seen royal colleges and professional bodies move from neutrality to opposition as the details of the proposed legislation have become clearer. At the same time, members are being asked to approve legislation in which important safeguards will, ultimately, be determined through secondary legislation and processes beyond the direct scrutiny of this Parliament. That should make us all pause.
If the legislation fails, it will not fail in theory; it will fail in real lives. As several speakers have said, under such a system, one mistake would be one too many. None of us can stand here today and say with certainty that the framework before us would eliminate that risk.
Opposing the bill must never be mistaken for indifference to suffering. It is quite the opposite. Our responsibility is to ensure that every person in Scotland receives the care that they need at the end of their life. Wherever someone lives in Scotland, they should have access to high-quality palliative care, effective pain relief, skilled medical support and the compassion that allows them to die with dignity. That means that we need serious investment in palliative and end-of-life care and honesty about the gaps that still exist across our country. Many members across the chamber have spoken about the need to strengthen those services. On that point, I believe that we are all united.
I will vote against the bill. When doubts remain about a decision of this seriousness, caution is the wiser course. On a matter of life and death, the Parliament must be certain before it changes the law.
21:25
As I rise to make my last contribution to a debate in this Parliament after some 27 years, I cannot think of a more consequential debate taking place during my time here. I offer my congratulations and thanks to Liam McArthur and to colleagues across the chamber for what has been a very dignified and considered debate to this point.
We all care about people dying and want to see good deaths for those whom we love and for ourselves. However, the bill would not just create a new option for a few. If enacted, it would impose a new reality for every person towards the end of their life—the option of assisted dying. In my view, it would change life and death for everyone. In our consideration of the bill, we should be particularly mindful of the impact that it could have on some of the most vulnerable members of our society, who lack agency in their decision making.
Last week, I shared my concerns that the safeguarding measures in the bill would not provide suitably robust defences against the risk of coercion. In 2018, as a Parliament, we listened to the voices of women who had suffered at the hands of abusers through domestic abuse. We listened to their plea to recognise the extent of coercive abuse, and we worked with experts to shape legislation to tackle the issue. Now, more than ever, I believe that we need to listen to those voices again as they warn us of the dangers that the bill would create.
Isabelle Kerr, who has run rape crisis centres in Scotland for decades, recently stated that the bill
“assumes that busy doctors will have the capacity and expertise to spot signs of abuse. My experience tells me that they won’t in most cases.”
She went on to say:
“MSPs need to realise that coercion will occur under an assisted dying law. In my view, the real questions are who will be coerced to die, and how many such deaths will be missed.”
She continued:
“This is a complex issue. Strong arguments are put forward by both sides … However, the success of legislation often boils down to its workability. I feel duty bound to point out that the Assisted Dying Bill at Holyrood is not workable in its approach to detecting coercion.”
Those are strong words—not from a person who opposes the law in principle, but from someone who is concerned about what we might call the constituency of very vulnerable people in our country. When supporters of the bill talk about choice and autonomy, they should remember that those are not the reality for some women, disabled people and older people who are trapped in abusive and coercive situations. We should be in no doubt that coercion would take place. No words in this bill would prevent it, because, sadly, not everyone who dies has people around them who truly have their best interests at heart.
Domestic abuse experts, such as Dr Anni Donaldson, have warned us that the bill
“risks offering a new, potentially lethal weapon to abusive men whose partners have been diagnosed with life-threatening or terminal illnesses.”
The Scottish Government’s evidence shows that, as we continue to have a hidden population of victims of abuse and coercion in Scotland, it is inevitable that that population will include individuals who are or become terminally ill. Abusive relationships do not end after diagnosis.
Although I recognise that those who support the introduction of assisted dying are eager to see legal change, we cannot and should not ignore the serious and real threat posed to vulnerable people through coercion.
Given the extent to which domestic abuse remains so prevalent in our society, coupled with the continued low rates of disclosure and the challenges of detecting coercion, it is inevitable that coerced deaths will occur if the Parliament agrees to the bill.
Therefore, to those members who remain torn about the bill, I respectfully say this: do not back it if there is any seed of doubt in your mind. Remember that there is no room for uncertainty when it comes to life and death. I urge members to vote against the bill at decision time.
21:30
I supported Margo MacDonald’s bill and Patrick Harvie’s bill on the matter. I eventually abstained on Margo’s bill. She told me to abstain for reasons that I will not repeat here, because I might get arrested.
I have found today that I come to this debate with no personal story to match some of the most profound and inspiring stories that I have heard across the chamber. Any personal story that I would bring would be quite feeble by comparison.
I have learned two things to my surprise in the debate. I will say this once and never again: I could have listened to Ross Greer’s speech again, and secondly, I might have preferred Krystle Ross to be the member of Parliament rather than her husband. That might be a sentiment that others would agree with this evening, having had time to reflect on it.
I pay particular tribute, as others have, to Liam McArthur, and not only to him, but to his team, going back to Jack, George and the other people who have helped since. The former of all those, when my head of office left in 2022, told me that he was adopting me as my unofficial carer, which was both charming and deeply alarming. They have worked incredibly hard to process the enormous volume of correspondence and work that Liam McArthur has had to progress during this session of Parliament. None could have done so with the charm, dignity, ease and restraint with which he has. His conduct in progressing the bill is, as others have said, a remarkable tribute to him and to this Parliament. He has done a fabulous job.
I stand here as someone, members will understand, who was not always terribly sure about this place, but I have come to have a profound respect for it. In fact, I have cherished its potential in the 19 years that I have been here, but not always its output. I remember when I first came in and looked around the chamber walls, I wondered, “What are these things?” I thought that they were bottles of whisky. I was told that that is the silent majority of Scotland looking at us as we debate the issues before us.
Over the years that I have been here, whether we were debating the ban on smoking, the groundbreaking legislation on improving the lot of people who require wheelchairs, the introduction of free personal care, same-sex marriage—I remember arguments about coercion being made at that time—or travel to the United States for women suffering as a result of transvaginal mesh, I have seen that when this Parliament works together, it is at its best. All those things, I have to accept, would probably not have advanced the social life of Scotland had this Parliament not been here to do it.
In this debate, I am reminded that each of us is equal. We are not loyal to any manifesto or any party leader tonight, however well intentioned their interventions might be. Each of us is an equal voice in the proceedings before us.
Today, I had quite a profound experience. I went into a Costa in my constituency before I came in here. There was a group of guys and a couple of women who talk about things every early morning. The Costa was very busy. I asked them what they would do if they were me and they all put up their hand in support, but that was not what was profound. I looked up and all around the Costa, other hands went up as well.
We should not forget, although it cannot be the only thing that governs our decision tonight, that the vast majority of the people of Scotland understand what is before us and support the progression of the bill.
The rest of this Official Report will be published progressively as soon as the text is available.