Assisted suicide is “inherently” unsafe and introducing it in Scotland would lead to serious injustices against vulnerable groups, critics have said.
Better Way, a campaign backed by medics, disability experts, and sociologists made the warning in a response to a call for views by Holyrood’s Health Committee. A selection of statements from Better Way’s response are included below.
Dr Miro Griffiths, Better Way’s spokesman, commented:
“Proponents of this legislation say it addresses unresolved issues identified in previous bills and provides suitable safeguards. We reject these claims.
“‘Assisted dying’ is inherently, and unavoidably, unsafe. There is no way to rule out abuses and mistakes, coercion, and people dying through pressures arising in society, such as their experience of loneliness, poverty, and other forms of inequality.
“MSPs should realise that supporting Liam McArthur’s legislation will mean opening the door to irreversible, unjust deaths. We need to chart a better path forward for people with terminal illnesses and others in Scotland.”
ENDS
Better Way campaign opposes assisted suicide, sets out an alternative vision, and provides a platform for marginalised voices. The campaign is supported by experts in several fields including medicine, disability advocacy, and sociology.
Find out more: Website| Social media Contact us: admin@betterwaycampaign.co.uk
Better Way’s response
The following statements are taken from Better Way’s submission to the Health Committee.
Coercion and pressure:
“Proponents argue that safeguards can ensure that overt forms of coercion are spotted. We do not believe this is possible, given doctors’ inability to screen patients properly for this issue. Coercion takes various forms and can be very subtle. In any case, other, less overt, pressures would come into play when a person is considering the option of assisted death.
Ultimately, patients’ decisions would be influenced, unjustly, by their socio-economic status, access to specialist care, and experience of various hardships such as loneliness, addiction, homelessness, relationship breakdown, and past trauma. Some patients may also feel that they are a burden on loved ones, or wider society. Others may feel that they should opt to end their lives in order to ensure that their inheritance is not spent on paying for care.”
Mission creep:
“Both countries that have long-standing assisted suicide or euthanasia laws and countries that have introduced laws in the last decade have witnessed significant expansion. In other contexts, we are witnessing constant pressure to expand legislation. This includes more recent laws frequently cited by ‘assisted dying’ campaigners.”
Eligibility:
“The definition of terminal illness in the Bill – an ‘advanced’, ‘progressive’ condition that a patient is ‘unable to recover’ from, which is expected to cause their ‘premature death’ – is very broad. At present, it could catch patients suffering from anorexia, and some disabilities.
The bill also creates confusion on whether a person with dementia is eligible. On one hand, dementia is a progressive, incurable condition that causes a person to die prematurely. This should make people with the condition eligible. On the other hand, it is intended that persons with a mental disorder should be excluded. This contradiction is not addressed.”
Safeguards:
“Doctor assessments do not include consideration of the patient’s wider circumstances, including their social status, family situation, access to support etc.
The involvement of a second independent registered medical practitioner is presented as a safeguard. It could be seen as the opposite. This professional’s lack of involvement with a patient means they are less likely to know of information in their medical or personal history that could be a cause for concern.
Section 7 specifies that doctors should consider an applicant’s ‘diagnosis and prognosis’. It’s important to stress that doctors’ opinions are fallible, and not infrequently wrong.
Sections 6, 8 and 15 specify that medical practitioners must ensure that a patient requested assisted suicide ‘voluntarily and has not been coerced or pressured by any other person’. We would submit that doctors are wholly unprepared to make this judgment, given that coercion can be subtle and hard to detect. Such assessments are inherently fallible and cannot be considered a ‘safeguard’.
There is no provision for assessment of pressures arising from a patient’s background or wider circumstances. As we have warned, a person’s decision to opt for assisted death will be affected by their experience of healthcare inequality, loneliness, poverty, family breakdown, addiction, and a host of other potential factors. People would inevitably opt to die because they lack sufficient support to live.”
Manner of death:
“Campaigners for assisted suicide believe it should be an option and describe it as a ‘safe and comfortable death’. Our allies, expert medics in relevant fields, reject this claim. A 2022 research paper in the British Medical Bulletin concluded that: ‘Evidence from jurisdictions where assisted suicide is legal reveals that some patients who ingest the prescribed lethal drugs experience distressing complications. There is also evidence that the drugs used for assisted suicide do not consistently bring about death quickly’.”
“The Bill does not attempt to address the issue of a botched assisted death, where a patient does not die from the substances provided. There are deep ethical questions involved with doctors’ response to this. Are medical professionals to intervene and ensure death, thereby participating in active euthanasia? Or are they to attempt to reverse the process? It is alarming that this very significant problem has not been addressed in the bill and is intended to be left to guidance.”
“A survey of Scottish palliative doctors by the Association for Palliative Medicine found that 8 in 10 doctors think assisted suicide would negatively impact the doctor/patient relationship. More than 4 in 10 also indicated that they would resign if the law changes and their organisations were required to participate in assisted deaths. The resultant impact on the profession of doctor resignations would undermine the quality of healthcare enjoyed by all patients.
A ‘good death’ can be assured through expert-led, well-resourced palliative care. It cannot be assured through assisted suicide, which is medically dangerous, results in harrowing complications, and can take hours and even days.”
Conscientious objection:
“On the issue of conscientious objection, we would draw attention to the concerns of Dr Mary Neal, reader in law at Strathclyde University. She states that: ‘Holyrood cannot legislate for conscience rights without express authority from Westminster. Without such authority, any such clause is quite simply ineffective. And she cautions that the burden of proof regarding conscientious objection is left to medical professionals: ‘…professionals who conscientiously object to assisted dying might find themselves challenged to prove in court on a balance of probabilities that they have an objection, or that their objection is truly ‘conscientious’. Doing so is likely to be practically impossible’. She adds that there is ‘a question mark over the bill’s competence on the basis that section 18 may not be compliant with the Human Rights Act’.”
Disability:
“Leading opponents of assisted suicide and euthanasia in Scotland and around the globe include members of the disabled people’s community. Dr Miro Griffiths, our campaign lead, and an expert advisor on disability, believes that legalising the practice will significantly impact disabled people. Dr Griffiths comments:
‘As a disabled person who is permanently struggling to have their needs met and be valued, and as a sociologist who questions how and why we organise societies, my feeling is that many people will opt for assisted suicide on the basis that they are fed up with the struggles they are experiencing. People will be so desperate to remove the injustices they face they will choose this option of death and to me that’s not a good rationale for having such a system.’
‘Assisted suicide will fundamentally change the way we understand life and death for marginalised communities, including disabled people. People are struggling on a daily basis to access sufficient support. Because of this, there can never be a safeguard that’s effective enough. If you don’t have accessible and inclusive societies, why would you even be contemplating the idea of marginalised communities being exposed to assisted suicide?’
Dr Griffiths highlights existing, negative value judgments that arise within healthcare and how they will affect decision-making under an ‘assisted dying’ law:
‘When I’ve gone to hospital, usually because my respiratory is declining, the question often asked to my partner, or to a family member, or even my personal assistants, is ‘should we place a do not resuscitate notice on Miro’s notes?’ Straight away the conversation is built upon the premise of ‘is this life worth saving?’ I know my life and the value placed on it is questioned. If you introduce a mechanism of assisted suicide you’re effectively saying, ‘we’ll still debate whether your life is worth saving but we’re also always going to have this option on the table now where your life can be ended’. This is increasing the levels of anxiety felt by myself and also others in my community.’”
Poverty:
“People experiencing poverty face various inequalities that place them at particular risk of injustice under an assisted suicide law. This important issue must not be overlooked.
Psychiatrist Professor Allan House states: ‘There are some very long-standing studies showing that access to primary care is affected by poverty. People in deprived areas have less access to a GP. GPs in poorer areas have bigger lists and see patients less often than GPs in affluent areas. Social inequality is matched by health inequality. How people access ‘assisted dying’ would be influenced by these factors.’
Cancer is one of the most-common serious illnesses affecting Scots. A report on the relationship between deprivation and cancer, published by Cancer Research UK, found that people living in more deprived areas in Scotland are more likely to get cancer and are 74% more likely to die from the disease than people in the least deprived areas. People in deprived areas are more likely to be diagnosed with cancer at advanced stages, given reduced awareness of symptoms, and lower attendance of screenings.
Research also indicates that people experiencing socioeconomic deprivation in Scotland have decreased access to palliative care services. And adults living in the most deprived areas of the country are twice as likely to experience mental health issues such as depression. We believe an assisted suicide framework would compound existing social inequalities, and single out the poorest in society for unjust treatment. People facing poverty may opt for an assisted as they lack the support to live. Ellen Clifford, of the organisation Disabled People Against Cuts, has also warned of this risk:
‘Following the introduction of the welfare state, suicides dramatically reduced in cases of poverty. The legalisation of assisted suicide threatens to bring back conditions whereby a person’s decision to end their own life as a consequence of social disadvantage is seen as a matter of personal choice rather than one of social injustice’.”
A better way:
“As a campaign, we believe that assisted suicide would be a dangerous and regressive path for our society. But we acknowledge that keeping the door closed to this practice is not enough. Our society needs to outline a better path for people with terminal illnesses, and other groups involved in this debate. We asked three of our expert allies to summarise their vision.
Dr Juliet Spiller said: ‘We need to ensure that every person living with a terminal diagnosis has access to all the support they need. That they are able to plan ahead, to identify what really matters to them, the treatments they want, the treatments they want to refuse. They need to be able to express their preferences and have conversations with healthcare professionals. Everyone needs to be on the same page and speaking from the same set of values.
‘The amount of political attention and resources dedicated to end-of-life care at present is miniscule compared to other areas of medicine and clinical practice. We need a much bigger focus on how we ensure everyone in Scotland has equitable access to excellent palliative care.’
Dr Miro Griffiths said: ‘For me, the better way forward is building a truly accessible, inclusive, and participatory society. Assisted suicide is incompatible with this aim. We need to remove it from the discussion and instead focus on what appropriate palliative care looks like. How do we make it well-resourced and available to all people as their health needs change? We need to ask what kind of health service we want and work to ensure people don’t feel ashamed or stigmatised because of how their bodies function. Once we have realised an accessible and inclusive and participatory society, my assumption would be that we’ll no longer need to debate the idea of assisted suicide.’
Professor Allan House said: ‘A better way forward for our society involves more imaginative thinking about how to address the mental health impacts of living with a severe physical illness. We have to understand how social context influences people’s thoughts about their own lives – for example their thoughts about living with a disability. And we have to join up our services. No doubt, services are better than they were decades ago, but we still have a long way to go in delivering high quality services to everybody living with a disability or severe physical illness who is moving towards the end of life. The best services are models of what every service should be’.”