Terminal Illness (Patient Choice)
The final item of business is a members' business debate on motion S3M-1452, in the name of Jeremy Purvis, on choices for people coming to the end of terminal illness. The debate will be concluded without any question being put.
Motion debated,
That the Parliament recognises and commends the committed work of all health professionals and carers who support patients with terminal illness; welcomes the advances in the palliative care movement over recent years that have benefited patients who are coming towards the end of terminal illness, specifically in the Borders; further welcomes national campaigns to allow patients to be aware of choices that they can make about their treatment and facilitate more patients to make the choice of dying at home, but believes, however, that there remain patients who wish to have greater control of their treatment and that it is right to debate allowing greater legal support for the choices that some patients may make to ask for assistance to die as they come towards the end of their terminal illnesses.
I am very supportive of the work of the palliative care movement in Scotland. I represent a constituency that has no hospice institution and relies heavily on the outstanding and caring work of the community palliative care staff under the consultant Dr David Jeffrey, for whom I have great regard. However, there are some people who are coming to the end of a terminal illness for whom the best palliative care available is not sufficient. They want greater control over the precise arrangements of their death. There is a choice gap in relation to allowing people to die at home for example. Marie Curie Cancer Care used that term in highlighting that, although 75 per cent of people say that if they had a terminal illness they would wish to die at home, only 25 per cent are likely to achieve their wish. A small number of those patients who wish to die at home would wish to have a greater say, when they are at the end of their life, over the precise circumstances of the timing of their death.
I wish to clarify my position. I do not propose euthanasia. I am not proposing a change in the law that will affect children. I am not proposing a change in the law that will affect all adults. My proposals concern not the elderly, the infirm or the depressed; they concern mentally competent adults with a terminal illness.
Although I acknowledge that the term is "physician-assisted suicide", the emphasis is not on a debate about suicide, in so far as that involves an individual choosing whether to live or die; rather, it is on situations in which an individual has been informed by two doctors that they have a terminal illness and the issue is how and when they die, rather than if.
I want to consider briefly the aftermath of the San Francisco earthquake in 1906. I will quote an eyewitness, the beer magnate Adolphus Busch. He said:
"The most terrible thing I saw was the futile struggle of a policeman and others to rescue a man who was pinned down in burning wreckage. The helpless man watched it in silence till the fire began burning his feet. Then he screamed and begged to be killed. The policeman took his name and address and shot him through the head."
I ask all those who will contribute to this debate, who are watching it or who are reading the Official Report whether they believe that the police officer in that incident should have been arrested for murder.
There will always be situations in which people can have their quality of life and their dignity robbed from them because of medical conditions, the disease that they suffer or the circumstances that they are in. People will address difficult times in different ways, seeking support from faith or medicine to assist them.
After a landmark case in 1996, the then Lord Advocate, Lord Mackay, issued a statement that he would not authorise the prosecution of a doctor if the doctor, acting in good faith and with the authority of the Court of Session, withdrew life-sustaining treatment from a patient with the result that the patient died. Commenting on the case, Professor Sheila McLean of Glasgow University's institute of law and ethics in medicine said:
"What our law does, therefore, is to endorse decisions which will result in the deaths of certain patients (most notably those who cannot express a preference) but not those who are competent to ask for aid in dying."
One person who is competent is a friend, whom I went to see on Saturday. He is in a palliative care bed in hospital. I have known him all my life. I have always respected him and he has been an inspiration to me, no more so than on Saturday. He has been and is a profoundly committed community and family man. Nothing is too much trouble for this former postmaster and councillor. He has been robbed of his physical, but not his mental ability by illness. He is a man of strong faith. He told me that he knows that he is leaving this world for a better one, and that his time to do that is now upon him. He has asked for treatment to be withdrawn and is now receiving only increasing amounts of palliative medicines. We do not know precisely the day that he will die, and that frustrates him. He told me that he is not afraid to die, and he has made the arrangements for his funeral. He has instructed that it will be forbidden for anyone to cry at his thanksgiving. His family is wonderfully supportive and loving, but I am not sure that it will be possible to obey all his instructions.
He asked for assistance to die and was told by his doctor, "This is not Holland." We do not blame the doctors. I have not done so when I have previously debated this issue. However, there was underlying frustration that, now that his condition is terminal and he is with his family and friends and is ready to go, he is being told that he cannot be helped. I told him of this evening's debate, and he asked me to argue ever more strongly for a safeguarded way in which people in his situation can choose a dignified ending when they are ready to go.
The annual reports from the Oregon department of health allow us to consider an area where such a provision exists. The summary report on the Oregon Death with Dignity Act 1997 that was published in March this year shows figures from 1998 to 2006. In 2006, 65 prescriptions for lethal medications under the provisions of the Death with Dignity Act were written. Thirty-five patients took the medication, 19 died of the underlying disease and 11 were alive at the end of 2006. That corresponds to an estimated 19.7 DWDA deaths per 10,000 deaths, in a state of the United States of America whose population is not considerably different from Scotland's. Ninety three per cent of the patients died at home and 87 per cent had cancer. There is now 10 years' worth of evidence in Oregon, with clear published information about reports to the authorities. There has been no discernible abuse. When I visited Oregon, I met the medical examiner and spoke with doctors in the regulatory bodies.
The debate is not about statistics, but I quoted those statistics because I have heard time after time in recent years that the law would be abused by a mythical queue of doctors who are waiting to abuse a new law even though they have every means available to them to abuse the current law.
Towards the end of their lives, most people consider how, when and where they will die. That is perfectly natural. We now give patients much greater information on how they will die and they have the power to decide where they will die, but they cannot decide precisely when they will die. My proposal neither undermines the sanctity of life nor concentrates on death more than life.
On 4 October 2007, I asked the First Minister whether he agreed
"that there is no reason why a parliamentary committee could not debate fully, in detail and sensitively all these legal issues".
He replied:
"The right to die is an issue of conscience. The Parliament's Health and Sport Committee has every right to investigate these matters, which I hope it will do."—[Official Report, 4 October 2007; c 2474-5.]
Whether it is the Health and Sport Committee, the Justice Committee or the Equal Opportunities Committee that considers the matter, I hope that there is consensus that an inquiry is due.
I have not persuaded colleagues before now to make the change to the law that would help my friend. I feel a deep sense of regret about that. My friend has celebrated life all his life and has helped others. He is frustrated, as I am. However, he has asked us, if we remember his life when he is no longer with us, to ensure that other people's wishes can be respected as they approach the end of their lives, if his wishes cannot be respected this week or next week.
It is customary at members' business debates to congratulate the member concerned on obtaining the debate, but, although Jeremy Purvis's persistence can definitely be acknowledged, I wonder at what point he will recognise that there is simply no enthusiasm in the Parliament for what he wants to do. That is surely borne out by the fact that his motion gained only one signature.
As vice-convener of the cross-party group on palliative care—I see that the convener, Michael McMahon, is here as well—my interests lie in a diametrically opposed direction. I seek an expansion of palliative care and an extension of the hospice movement, not the introduction of something that would have the opposite effect. I hope that medical science will increasingly allow us to ease the last few days, weeks, months or years of our lives, whatever the reason for our final breath. Nor do I expect heroic efforts always to be undertaken by doctors. Sometimes it is right that people be allowed to refuse further and perhaps painful and pointless interventions that will be effective for only a little time, but standing back and letting nature take its course is not the same as intervening deliberately to help nature along.
I said that palliative care is diametrically opposed to what Jeremy Purvis proposes, but I go further. What he proposes would have a detrimental effect on palliative care. I do not accuse him of malign intent. I am certain that he acts from the best of intentions, but he is profoundly mistaken, because with the best will in the world, his idea, if implemented, would lead us down a dangerous road.
The experience in other countries has been by no means as positive as has been presented. In the Netherlands, the law has been used to demand an extension of euthanasia for those in extreme mental distress. Involuntary euthanasia has also been practised there. I think we used to call that murder, actually. The Dutch guidelines have been almost unenforceable and constantly contravened. One Dutch study discovered that more than 50 per cent of Dutch doctors had actually suggested euthanasia to their patients and a staggering 25 per cent owned up to ending patients' lives without their consent. Brave new world, indeed.
Does the member have information on the percentage or number of doctors in this country who have owned up to effective euthanasia?
I do not know whether such figures exist. If they do, it would be interesting to have them.
When the law is changed, the position changes from being exceptional to being routine, and both palliative and hospice care begin to lag behind. Why bother, after all, if we are ending the lives of those who might benefit from that care? Oregon has fared little better—I acknowledge that Jeremy Purvis is trying to fix one of the deficiencies in the Oregon experience by confining his intentions to people who are coming to the very end of terminal illness, but palliative care has been compromised there and that is a consistent pattern. Members will all have received the British Medical Association's briefing for this debate—the BMA's position is implacable, and rightly so. However much sympathy we may have for those who are dying and wish to hasten their own end, they do not have the right to demand that other parties be implicated in that process.
The member will know that two years ago the BMA voted to be neutral on the issue, and it has now gone back to its former position; so opinion is finely balanced within the BMA. Given that I have visited and spoken to the palliative care movement in Oregon, will the member acknowledge that the movement has been supportive of the Death with Dignity Act rather than opposed to it?
We can trade studies, and I have seen studies that suggest that the situation in Oregon is by no means as positive as the member suggests. The profoundly destructive nature of the change in the law for the relationship with all medical staff cannot be overstated. There have been a massive number of opt-outs for conscience reasons, followed by a decision that those with serious concerns should stay out of those branches of medicine in which it will become an issue.
There are practical reasons for not going down that road, but ultimately there is another, higher reason: it is plain wrong in itself, morally and ethically. For goodness' sake, let us concentrate on alleviating pain and suffering to ease death, not to bring about death as the member advocates.
I commend Jeremy Purvis for securing the debate. Although I profoundly disagree with the member on every aspect of his argument, it is admirable that in the face of continuing and overwhelming opposition from colleagues here, the medical professions, numerous voluntary sector carers groups and even his own political party—the members of which voted against his position at the Aberdeen party conference—he continues to plough his futile furrow.
In the short time that is available to me it is not possible to rehearse all the reasons for opposing the motion. With the overwhelming evidence and array of concerns about Mr Purvis's intentions, it would entail a difficult debate, and it is difficult to know where to start on his position on euthanasia. He can call it whatever he wants—it is euthanasia. I could use religious or ethical arguments, but I have neither the theological nor the ethical knowledge to expound on those in any great detail.
I appreciate, however, that in June 2006, when doctors voted overwhelmingly against legalising physician-assisted suicide and euthanasia, the BMA made it absolutely clear—as mentioned in the briefing that was sent out to members of the Parliament in anticipation of this debate—that properly resourced palliative care makes euthanasia unnecessary. Euthanasia is a desperate, negative and ultimately fruitless method of dealing with the issues that affect the terminally ill. It might be a cost-effective way to treat the terminally ill, but it will undoubtedly discourage the search for cures and treatments and it will undermine the motivation to provide good care and pain relief for the dying.
Does the member contend that there is effective palliative care for every condition, or does he accept that there are some conditions for which there is no effective palliative care?
Those who participate in palliative care would argue that there is effective palliative care for every condition. Euthanasia is an inherently selfish concept that ignores the danger that vulnerable people will come under pressure to end their lives. Elderly and sick relatives will be coerced by selfish families, or face pressure to free up medical resources. Patients whose families believe that euthanasia is the only solution will be abandoned.
Palliative care can be enough to prevent a person from feeling any need to contemplate euthanasia. A sick person matters to the last moment of their life. Medical professionals can help someone to die peacefully, but also to live until they die. They key to successful palliative care is to treat the patient as a person, not as a set of symptoms or a medical problem. As the World Health Organization states, palliative care
"affirms life and regards dying as a normal process; it intends neither to hasten or postpone death … it provides relief from pain"
and suffering, and it
"integrates the psychological and spiritual aspects"
of the patient. Good palliative care is the alternative to euthanasia. If it were available to every patient, it would certainly reduce the desire for death to be brought about sooner.
Mr Purvis used the example of Oregon, as do most people who support his position, but the reality is that comparing Oregon with Scotland is comparing apples with oranges. The hospice movement and palliative care in America are not the same as the hospice movement and the palliative care service in Scotland.
Ending a patient's life by injection is quicker, easier and cheaper than palliative care and many people fear that introducing euthanasia would reduce the availability of palliative care, because health systems would inexorably veer towards the most cost-effective ways of dealing with dying patients. Providing palliative care can be very hard work, physically and psychologically, and it is dearer than euthanasia. If we concentrated our efforts on ensuring that palliative care and the hospice movement were adequately resourced, positive and effective end-of-life care could become more widely available throughout Scotland.
Proper palliative care makes euthanasia unnecessary. I urge Jeremy Purvis to divert his efforts into fighting for the positive palliative route towards a person's death and away from his negative and destructive solution.
I thank Jeremy Purvis for giving us the opportunity to debate the motion. I agree with him that everyone has the right to a dignified end to life. My party has a free vote of individual conscience on the issue, so the views that I express are personal.
In March 2004, the House of Lords debated a bill, the purpose of which was
"to provide an option for terminal patients who are suffering unbearably to bring an end to their suffering".—[Official Report, House of Lords, 10 March 2004; Vol 658, c 1316.]
My starting point is that no one should suffer unbearably. I acknowledge the excellent work that Michael McMahon has done in the Scottish Parliament's three sessions to raise awareness of and bring about improvements and excellence in and better access to palliative care.
Gil Paterson and I run the cross-party group on chronic pain, which Dorothy-Grace Elder established in the first session and which Jean Turner and I ran in the second session. Jeremy Purvis is welcome to join that group. I am pleased to say that tremendous progress in dealing with chronic pain has been made through the McEwen report, the new NHS Quality Improvement Scotland report, a managed clinical network in Glasgow, the development of QIS clinical standards and meetings between pain consultants and the Scottish Medicines Consortium to ensure that drugs to alleviate pain are given due consideration to achieve better patient care.
No terminally ill person in Scotland should suffer unbearably if this Government—like the previous one—takes seriously palliative care and the treatment and management of chronic pain. I pay tribute to all the staff who work in the national health service, in hospices, in primary care and in the voluntary sector—particularly in Marie Curie Cancer Care, which Jeremy Purvis mentioned—to support patients who suffer from persistent and chronic pain. Please let us not make people afraid that they will suffer unbearably when they are dying. Palliative care services and pain management are improving by the day, although there is still a long way to go to achieve equal access, as Jeremy Purvis said.
For several reasons, I do not support Jeremy Purvis's motion. I do not want any person to be frightened of pain when they are dying. I do not want anyone to feel that they are being a burden by taking up an NHS or hospice bed. I do not want anyone to think that their life is worth less than another's or that they have outlived their usefulness. No person should feel obliged to choose to die sooner than nature dictates because, for example, they are worried about being a burden or about the financial implications for other family members of a long-term illness.
Another issue is trust between a doctor and a patient and the honouring of the Hippocratic oath and the duty of care by all doctors. It can be difficult to interpret the wishes of a terminally ill patient if they are delirious, confused or—as in many cases—depressed. How can a clinician be absolutely confident that a request for a life to be ended sooner does not arise from a person's state of mind, whether or not that state of mind is treatable?
Finally, the BMA's briefing for the debate is excellent. I would have thought that no politician should force doctors who voted by an overwhelming majority against legalising physician-assisted suicide and euthanasia to change their minds.
There is no question in my mind about the importance of this debate. I, too, congratulate my friend and colleague Jeremy Purvis on securing it. I am sure that he has again been made well aware of the feelings of members throughout the chamber on the issue. Like other members, I welcome the opportunity to contribute. I agree that it is entirely appropriate that there should be such debates in the Scottish Parliament and in wider Scottish society.
Many people and organisations outside the Parliament attempt to portray moral issues in easy, dogmatic, black-and-white terms. As a Christian—I make no apology for saying that—I believe in the sanctity of human life, but as a liberal I fervently believe that I cannot impose my moral beliefs on other people. I follow John Stuart Mill's philosophy that people should be free to take their own actions—and be responsible for those actions—as long as they do not cause serious harm to others. In that context, I have real difficulty with the motion and assisted dying for the terminally ill.
I believe that if the law were changed to make suicide legal in certain circumstances, as Jeremy Purvis wants it to be, immense pressure would be brought to bear on the most vulnerable people in our society—those who know or fear that they are near the end of their time here. I do not think that people in such circumstances would really have a free choice. What messages would we be sending them? Would we be saying that they have outlived their usefulness and that they are a burden on society? That does not have to be done in clear ways; it can be done in unclear ways.
The issue of free choice is central to the debate. Everyone in our civilised society has a right to life. We are talking about the possibility of changing Scots law to allow people to ask for assistance to die as they come towards the end of a terminal illness. I do not believe that any proposals could deal with the indirect coercion that could—and I am sure would—occur in such circumstances.
If a vulnerable patient is surviving only because they are receiving life-sustaining treatment or nutrition and water, what protections currently exist against subtle pressure being brought to bear by the type of people whom the member has mentioned that could result in that patient making a request for that life-sustaining treatment to be withdrawn?
As I said, we are not talking about easy, black-and-white issues. There is quite a difference between withdrawing somebody's life support and assisting in their death.
There is no doubt in my mind that the change to Scots law that Jeremy Purvis is championing has been proposed for the best of reasons. He wants to change the law to help people in the direst circumstances, but I cannot support what has been proposed. As a liberal, I understand Jeremy Purvis's arguments, but I firmly believe that we would break John Stuart Mill's fundamental principle of freedom if we changed the law. We should not change the law to allow people to ask for assistance to die because that would precipitate real and devastating harm to the most vulnerable people in society. I urge members not to support such a change to Scots law in the event that the proposal comes before us in the future.
I congratulate Jeremy Purvis on securing the debate and hope that everyone accepts that there is good faith on both sides. As Mike Rumbles said, the issues are not black and white. There is no desire to end people's lives casually or to prolong people's agony unnecessarily.
As a general practitioner for most of my professional lifetime, I have devoted many years to caring for patients. I have shared the good times as well as the bad times with people whom I now consider to be more friends than clients or customers. There can be nothing more precious than helping someone whom one has known for years to end their life in dignity and in circumstances that they have chosen when the time comes.
The care of people with a terminal illness has improved immensely. It is strange to look back at a time when hospices did not exist in Edinburgh. In those times, people with terminal cancer were sent to hospital to end their days in a most inappropriate setting or—perhaps worse still—left languishing at home with scant support for themselves or their relatives. Today, we have not only hospices but teams of devoted and experienced professionals who help such people to stay at home, help them to manage intractable pain and remove much of the fear that inevitably surrounds people when they are at the end of their days. How often I have heard laughter restored to a home that previously knew only fear.
The motion is right to draw attention to the great advances in palliative care and the committed work of all who administer it and otherwise care for the terminally ill—yet, sometimes, even that is not enough. There are people who, for reasons that are right for them, do not wish to live life to the bitter end. They may have the same condition as a parent had and know exactly what is in store for them. Whatever the reason, it is right that we at least consider whether there are any circumstances in which society should consent to help them to achieve their desired end.
The motion deliberately does not go into specifics, which should be the subject of prolonged and intensive debate. For example, it is vital that patients do not have the perception that the doctor who is looking after them might be part of a team that ends life. We need to learn lessons from countries where such a right already exists and see how it works in practice. The nature of the consent and the method by which someone's wish to die is assisted are just two more issues that require extensive debate before any legislation can be introduced, but it is a debate that we should have.
I have every sympathy with those who find even consideration of the topic repellent. I can think of only one or two patients in my time as a GP who I thought genuinely wanted to end their lives at a time chosen by them, but I regard it as a failing in our system of care that that course was not open to them. In my experience, and despite what has been said today, palliative care is not always effective. When it is, the need for other measures will probably fade away. Let us take the first step in the debate by continuing to discuss the issues that are so important to us all.
Dr McKee has demonstrated the difficulty that the medical profession faces in this debate. We want to do our best for patients by supporting them and supporting their wishes, but being involved in ending life when one's whole creed is based on sustaining life presents an enormous difficulty. I met the group to which Jeremy Purvis referred. After discussing the topic, I was still left wrestling with it, rather as Dr McKee is.
I began my work in the field back in the early 1970s, as part of a team that comprised a surgeon, a psychiatrist and a nurse who were supported by the Scottish Health Education Council to go round Scotland to raise the issue of palliative care. The first hospice in Edinburgh was founded at that time and St Joseph's hospice in London had just been founded. After that, I was associated with the group that founded Strathcarron hospice. I served on the hospice's board of management and eventually served as its chair over a period of some 12 years. In a sense, a lot of my professional life has been associated with the end of life as well as with supporting sick people in other ways.
Occasionally, despite all the best efforts being made, palliative care is insufficient to prevent death being difficult, troubled and disturbing for the individual and the relatives. It is not perfect, but I believe that we have made progress. It was, frankly, a disgrace throughout the United Kingdom. The journey is not yet complete by any means, but there have been enormous advances.
It is vital that we focus on palliative care at home, because the purpose of the hospice movement is to provide symptom relief and restoration of the best possible function, and to allow people to return to where the overwhelming majority wish to end their lives—at home. At the moment, that does not happen because there is inadequate symptom control, because palliative care teams are not strong enough, because there are not adequate resources to maintain primary care teams or because individuals feel that they will become an overwhelming burden on their relatives.
People fear death. We cannot remove that fear totally from patients, but in the overwhelming majority of cases we can take away fear of the symptoms that are associated with death. In my experience, the vast majority of people accept psychologically the process of death and dying as natural for them and as a transition that does not require assistance.
At this stage, we should not amend the law. We should continue the debate and discussion that is under way, promote palliative care at home, ensure good symptom control and ensure that living wills and advance directives, which we have debated in the chamber, are sustained and improved. The burden on individuals and professionals of introducing euthanasia is too great. Thank God we are not in the same situation as America, where 40 per cent of bankruptcies are caused by health problems. Patients here are not subject to the same stimulus to desire death to lift a burden on themselves. The time is not yet right for Jeremy Purvis's motion, but I thank him for giving us an opportunity to debate the issue.
I am sorry that Jeremy Purvis has chosen to raise this issue again, scarcely three years after his previous members' business debate on dying with dignity and the Parliament's detailed consideration of his attempts to have the concept of assisted dying for terminal patients embedded in Scots law.
Much of the motion is completely uncontroversial. Of course we recognise and commend
"the committed work of all health professionals and carers who support patients with terminal illness"
and welcome
"the advances in the palliative care movement over recent years"
that have been of immense benefit to people facing end-of-life problems and to their families. We also support campaigns such as that led by Marie Curie Cancer Care to raise awareness of treatment options and to help to realise the wishes of those who want to die at home, in familiar surroundings, with their loved ones, pets and treasured belongings close by.
We cannot and should not prevent discussion of what Mr Purvis describes as
"allowing greater legal support for the choices that some patients may make to ask for assistance to die as they come towards the end of their terminal illnesses."
However, as I said during the 2004 debate,
"For me, a former health professional who is bound by the Hippocratic oath and trained to improve and prolong life where possible, the idea of actively and deliberately ending a human life is disturbing."—[Official Report, 11 November 2004; c 11883.]
Although I understand Jeremy Purvis's concerns, based on the tragic examples that he has cited this evening, I think that his proposal would risk undermining patient trust in doctors and medical advice. Although I regard as acceptable the withdrawal or withholding of life-prolonging treatment from a terminally ill patient who no longer wishes to have it, that is a long way from actively assisting a terminally ill patient to die. I accept that pain relief, to be effective in dealing with a terminal illness, may on occasion have to be given at levels that exceed the limits of tolerance, but that is different from deliberate physician-assisted suicide, which would be a dangerous concept to enshrine in law.
As Jeremy Purvis's motion states, in recent years there have been significant improvements in palliative care. The spreading implementation of the gold standards framework of palliative care, together with on-going work by Marie Curie Cancer Care and others, should make it possible before long for the vast majority of patients to experience a dignified and comfortable death when that inevitability arrives.
End-of-life care is as vital a part of health care as any that a patient receives throughout life. It is my sincere belief that good palliative care that takes the fear and pain out of dying is far better than exploring the route to euthanasia and legally assisted suicide. I know of very few people in the health care professions who believe that we should be heading down that route. I very much agree with the BMA's opposition to assisted dying, backed by a large majority of its members. I also agree strongly with the BMA that good, effective palliative care must be made more widely available throughout Scotland and that that is the goal towards which we should all be working.
Because a couple of members are still waiting to speak, I am minded to accept a motion without notice to extend the debate by up to 10 minutes.
Motion moved,
That, under Rule 8.14.3, the debate be extended until 5.55 pm.—[Jeremy Purvis.]
Motion agreed to.
Although I recognise Jeremy Purvis's commitment to this cause, I am somewhat disappointed that we are revisiting the debate after just over three years. I had thought that he would recognise that there is no political, public or professional support for the introduction of euthanasia in Scotland.
So far, no member has explained why the result of the previous BMA vote was clearly in favour of neutrality, although the result has since changed due to the balance of opinion in the profession. Is the member saying that there is no public support for euthanasia? It is clear from opinion poll after opinion poll that people think that there should at least be a debate on the subject, whereas some members are saying that there should not even be a debate in the Parliament.
There is a big difference between the public wanting to have a debate and their supporting euthanasia.
The BMA's briefing is clear, so I will quote from it for Jeremy Purvis's sake. It says:
"In 2005, the BMA considered the merits of allowing Parliament and society at large to decide this controversial matter and took a neutral stance. In 2006, however, BMA members voting at the annual meeting made clear that the majority oppose"
the idea of introducing physician-assisted suicide. The BMA's position is clear. It has gone from a position of neutrality to one of opposing euthanasia. I believe that the direction of travel in the debate is to oppose euthanasia. The BMA has taken a firmer stance on the matter since the time of Jeremy Purvis's previous debate.
The birth of life is a natural process and death should also be natural. Those who actively promote euthanasia state that it is their human right to decide when they should actively end their life. Under the European convention on human rights and considerable case law on the subject, there is no such right to die.
I turn to the impact that euthanasia could have on the doctor-patient dynamic. To provide a doctor with a licence to kill or to assist in euthanasia would give that doctor a role that does not sit comfortably with their role as a healer and carer. Such a role would fly in the face of the Hippocratic oath and would undoubtedly impair the doctor-patient relationship, which is founded on trust. The doctor-patient relationship would be seriously compromised if patients could not express their distress lest it led to the possibility of euthanasia.
Doctors and nurses should not be put under any pressure to consider the possibility of assisted suicide, nor should patients have to feel under pressure to consider the same possibility should they be in a state in which they might be considered for assisted suicide. The BMA also highlighted that issue as one of the potential downsides of any change to legislation.
Euthanasia is not simply about deciding whether to switch off the life-support machine; it is about deciding whether a person should die. It is a form of suicide that cuts short a person's life. The case law to which Jeremy Purvis referred has more to do with switching off life support than it has with actively promoting a person's death.
I turn to the bigger picture. As a society, we could consider going down the route of allowing people to make this type of decision, with all the implications that that entails. However, if we did that, too many people would be put into the position of having to consider the value of their life. I do not believe that that is a healthy place for society to be.
It is very healthy for all of us to consider the value of our life. In fact, it should be mandatory for the human condition. We should all concern ourselves with the contribution that we make to society in general throughout our life, right up to the moment of death.
As the chamber knows, I have a degenerative condition. I would like to have the right to determine by how much my capacity to fulfil my social, familial and personal functions will be truncated. I would like the ability to take that decision. I do not want to burden any doctor, friend or family member; I want to find a way in which I can take the decision to end my life in the event that I am unlucky enough to have the worst form of Parkinson's near the end of my life. From the responses to interventions, we can see that the medical practitioners among us have admitted that palliative care is not as effective in all cases as everyone wants it to be. I am mindful of that. I may be one of the unlucky ones. I apologise for the personal nature of my contribution, but this is not theory for me.
I fully appreciate why Michael Matheson wanted to invoke the law. However, in this case, yet again the law may be an ass. To say that it is illegal for anyone to force themselves to die is to deny the bravery of countless soldiers over the ages. People have taken that decision for one reason or another. It is just that we are now accepting that it is possible for someone to take that decision when they are in sound mind and they can do so in a measured capacity.
I am mindful of what the doctors say and how difficult it is for them. However, I have read the personal testimony of doctors and have seen doctors who have admitted in court to assisting a suicide. They are no less doctors in my estimation for having done that.
I congratulate Jeremy Purvis on bringing the debate to the chamber as quickly as he could. Many people have a lot less time than I have.
I join Margo MacDonald in thanking Jeremy Purvis for bringing the motion to the chamber. I thank all members who contributed to the debate.
I believe strongly that the chamber should be a forum for debating difficult and sensitive issues—issues on which we take different views. The quality of this evening's debate has done the Parliament great credit.
At the end of my remarks, I will turn to the issue of whether people should have the right to seek assistance to die. Before I do so, I take the opportunity—very deliberately—to set out our plans for palliative and end-of-life care. In my view, it is impossible to overstate the importance of good-quality palliative care that is based on the wishes and needs of patients. I agree very, very strongly with Roseanna Cunningham, Michael McMahon and other members that our clear focus must be on improving palliative and end-of-life care services. As Ian McKee and other members said, much still needs to be done to ensure that we provide the quality and range of services that people have the right to expect.
I place on record my great admiration and support for the work that professionals, volunteers and carers do to support people who are in the final stages of terminal illness. Over the past few months, I have had many opportunities to see that work for myself during visits to hospices and when I launched the new dedicated palliative care ambulance in Tayside last year, which is a commendable example of partnership working between the NHS and the voluntary sector.
The presence of so many members in the chamber undoubtedly reflects the sensitivity of the issue and the deep-rooted feelings that we all have about the importance of ensuring that people who have been diagnosed as suffering from a life-ending illness receive the most appropriate care. People who are terminally ill and are nearing the end of life must receive the best palliative and end-of-life care available. I take seriously the Government's obligation to ensure that such care is delivered, which is why in our "Better Health, Better Care" action plan we made a clear commitment to strengthening palliative care services throughout Scotland.
We are committed to ensuring that the NHS takes full account of the recommendations of the Scottish partnership for palliative care report, "Palliative and end of life care in Scotland: the case for a cohesive approach", which supports a single approach—for the first time—to palliative and end-of-life care provision throughout the country.
Our aim is and must be to ensure that palliative and end-of-life care will be provided to anyone who requires such care, regardless of diagnosis, to ensure quality of life for patients and their carers and families. As Mary Scanlon and other members said, we must ensure that people do not suffer unbearably during the final stages of life.
Mary Scanlon urged the Government to maintain the momentum of the previous Government on improving palliative care services and I assure her and other members that we will do so. Our palliative and end-of-life care action plan will be published later this year. The action plan will focus carefully on the recommendations of the Scottish partnership for palliative care report and it will incorporate developments that have been made since the report's publication. We will write to NHS boards and key stakeholders by the end of the month to set out our plans. To support and drive that work, a national clinical lead for palliative care has been appointed, and every NHS board has an executive-level lead.
I agree strongly with Jeremy Purvis that people must have greater choice about where to die. I praise the Marie Curie Cancer Care supporting choice campaign, which has highlighted a desire among patients who are suffering from an end-of-life illness to be treated and to end their life at home if possible. That choice should not be questioned and we should encourage the development of services to support it. Community health partnerships and managed clinical networks play a crucial role in enabling patients to remain at home during the terminal stages of their illness, by allowing for the integration of specialist palliative care and primary health care teams. Such an approach is vital if people are to have the right to choose to die at home, as many people want to do, if that is at all possible.
On the final point in the motion, many members mentioned the parliamentary debate on the issue that was held in November 2004. The position has not changed since then. Although suicide is not illegal in Scotland, actively assisting someone to end their life is illegal. If the issue comes before the Parliament again it will be a matter of conscience that will require careful consideration. However, although I appreciate that there are many strongly held views, I detect no consensus that there should be a change in the law. Indeed, although I respect the views of Jeremy Purvis, Margo MacDonald and other members, I share the concern that members expressed about the consequences of a change in the law; about the difficulty of ensuring adequate safeguards; and about the danger of making terminally ill people, particularly elderly people, feel under pressure to end their lives. It is extremely important to acknowledge, as members have done, the fundamental difference between refusing life-prolonging treatment and seeking active assistance to die.
Our view remains that patients' wishes should be respected as far as is practicable and possible, but that the provision of care and treatment must be within the confines of the law. At this stage, we have no plans to change the law, although I repeat the First Minister's comment that it is open to any parliamentary committee to examine the issue in more detail if it wishes to do so. I hope that our plans for palliative and end-of-life care demonstrate our deep commitment to improving the quality of life of people with terminal illness and their families and carers. That is where our efforts should be focused.
I hope that what I have said assures members and the public that patient choice is uppermost in our minds when we deal with end-of-life issues. We will continue to seek to ensure that suitable choices are available and that the wishes of individuals and their families are respected.
Meeting closed at 17:55.