Dr Miro Griffiths at home

‘Assisted dying’ can never be made safe

Supporters of ‘assisted dying’ describe their desire for a narrow, safe law but the truth is they cannot guarantee this – no matter how the law is drafted, writes Dr Miro Griffiths.

New ‘assisted dying’ legislation will be introduced to Holyrood in the coming months. A bill by Scottish Liberal Democrat MSP Liam McArthur would give people who are terminally ill and thought to have less than six months to live access to drugs that will end their lives – provided certain requirements are met. For those who support these proposals, they’re about granting suffering people the right to die when they choose. For others, they represent a dangerous idea that would see the vulnerable and marginalised in society placed at risk of irreversible harm. As a disabled person, an expert advisor, and a socialist, I firmly oppose the plans.

I appreciate the strong feelings bound up with this topic – often rooted in personal experience, or the experiences of loved ones. I also approach this debate with personal, as well as professional, concerns. I have health conditions that are categorised as “life-limiting” and “progressive”. My strength, respiratory functioning, and swallowing will continue to deteriorate. Physical movement is primarily limited to my fingers, I require a power wheelchair, 24-hour personal assistance, and various medical interventions every day. I hope readers will realise that I, and many others in my community, approach this issue in a way that others in society will not.

Whilst I understand the arguments for ‘assisted dying’, and recognise the laudable intentions of proponents, researching this topic for years has convinced me the practice is inherently unsafe. A law change is just too dangerous, especially in a context of overburdened public services, and deeply embedded social inequalities. A timely example of assisted dying’s dangers is Canada’s Medical Aid in Dying (MAiD) regime. Data shows a tenfold rise in assisted deaths since Canada’s law was changed in 2016. The law has quickly expanded, and there are reports of vulnerable or marginalised people feeling forced to opt for assisted death due to an unjust lack of better options.

Alan Nichols, a vulnerable 61-year-old, made headlines in 2022. He was assisted to die on the grounds of “hearing loss” just weeks after being hospitalised due to his declining mental health. Another man, Roger Foley, says has been pressured to opt for assisted death by medics, given the costs associated with his care. In September, a former Paralympian said she was informed of her right to MAiD after enquiring about a wheelchair lift for her home. In the last two years, Canadian veterans have also complained about being signposted to assisted death when seeking help due to their injuries. A troubling ableist culture appears to have sprung up around this “healthcare right”.

In August, a woman reported that she was pointed to ‘assisted dying’ after seeking help for suicidal thoughts. The doctor who met with her said mental health services are overwhelmed. This chilling case underlines the danger of putting life-ending interventions alongside traditional, more resource-heavy forms of support. We’ve also seen Quebec authorities issue a memo to MAiD providers warning of “borderline compliance” with rules, the bypassing of a two-doctor requirement, and ‘doctor shopping’ by patients. Medics were reminded that people are not eligible for assisted deaths on the basis of “advanced age”. This casts serious doubt on compliance with “safeguards”.

To try and mitigate a slew of ‘bad press’ from Canada, Scottish campaigners invited a Canadian medic to visit Holyrood, to dispel what he calls “misinformation”. The doctor in question, a long-time campaigner for euthanasia, believes Canada’s law is working well. Esteemed experts in his country would challenge this contention. Palliative expert Leonie Herx previously spoke to MSPs. Assisted dying campaigners also stress that a Scottish system would be different to Canada – stricter and more limited, like Australia and New Zealand. The problem with this assertion is that in other nations where the practice is legal, supporters said the same thing. Intention does not necessarily match outcome – and with this issue, it never does.

Canada’s law was meant to be narrow and strict. ‘Assisted dying’ was initially for people with terminal illnesses whose deaths were deemed “reasonably foreseeable”. However, it quickly became permissive. Disabled people whose deaths are not “reasonably foreseeable” are now eligible. From next year, people with mental illnesses will be eligible as well.  A similar story of expansion can be seen in Belgium and the Netherlands – countries with long-standing euthanasia laws. Switzerland is permissive. And in California, assisted deaths have climbed significantly after a mandatory waiting period was cut by 13 days.

Some say Oregon is a good model but experts point to declining health care in the state, failed safeguards, and questionable circumstances surrounding deaths. Data recording is limited but the data we do have confirms poor medical oversight, and serious complications at the time of death. Australia and New Zealand – which Scottish campaigners laud – are similarly problematic. In the Australian state of Queensland, news recently broke of a man who used the lethal medication prescribed to his wife to end his own life. Australian officials are said to be re-thinking rules but for the family and friends of this man, it’s too late. Their loss cannot be undone.

We also see reports of an impact on palliative care – despite claims by campaigners to the contrary. Two weeks ago, it was reported that the government of New South Wales, Australia, has cut $150 million of palliative care funding, whilst injecting money into ‘assisted dying’. Palliative experts in the UK also warn of an impact, were our laws to change.

Then there’s the pressure to expand laws. Legislators in one Australian state are considering removing a “time frame to death” requirement, as “estimating life expectancy is inherently uncertain”. They say people being eligible for assisted death earlier in their condition reduces stress. Doctors in the state of Victoria have threatened legal action if rules preventing less-rigorous assisted suicide consultations on the phone and via Zoom aren’t changed. Whilst in New Zealand, the architect of its ‘assisted dying’ law is challenging a rule limiting access to those with six months to live. The direction of travel with these laws is easier access, for more people.

Supporters of ‘assisted dying’ describe their desire for a narrow, safe law but the truth is they cannot guarantee this – no matter how the law is drafted. Safeguards fail, are eroded, and are dispensed with. Laws expand. When this happens, disabled people, the poor, the vulnerable and the marginalised are worst affected. The only sure way to avoid abuses and permissive legislation is to keep the Pandora’s Box of ‘assisted dying’ closed.

There is a better way forward for Scotland, involving improvements in end-of-life care, greater suicide prevention, and better affirmation and inclusion of marginalised communities. I urge MSPs to choose this path.

Dr Miro Griffiths, disability policy advisor, Disability Studies scholar, and spokesperson for Better Way This article was originally published in The Herald on 11 October 2023.