cover2 1

‘Assisted dying’ cannot be made safe – report

‘Assisted dying’ would give rise to profound injustices affecting the most marginalised in Scottish society, a new report warns.

‘Still Not Safe’ highlights expert opinion and a range of evidence and concludes that there is no way to make ‘assisted dying’ safe.

The report was produced by Better Way, a campaign against a change in the law supported by experts in medicine, disability advocacy, and sociology.

Eight conclusions are listed on: terminology; the process; safeguarding; palliative care; suicide prevention; disability; poverty; and Canada. A summary can be accessed here.

Speaking ahead of the report’s launch, Dr Miro Griffiths MBE, spokesman for Better Way and an expert adviser on disability policy, commented:

“I’m pleased to mark the launch of this report today. It considers a range of issues around ‘assisted dying’ including the dying process itself, safeguarding, palliative care, and suicide prevention, and cites both expert opinion and a range of evidence. Ultimately, it concludes that a change in the law would be too dangerous.

“Whilst we recognise that calls for ‘assisted dying’ are well-motivated, there is simply no way to make it safe. The injustices it would inevitably give rise to would affect the most marginalised in Scottish society. We need to chart a better path forward for people with terminal illnesses and others in Scotland. To do this, MSPs must oppose a change in the law.”


In a foreword to the report, Dr Griffiths states:

“Our campaign is opposed to a change in the law. As experts in different fields, we believe the problems and dangers associated with this practice – articulated by many groups in past parliamentary debates – have not been resolved by proponents. As the title of this report suggests, ‘assisted dying’ is Still Not Safe. Indeed, we believe it will never be.

“Allowing this practice in Scotland would give rise to profound injustices. Injustices that affect disabled Scots, Scots facing poverty, Scots who are isolated and lonely, and many others. No amount of legal drafting could rule out Scottish citizens electing to end their lives because they lack sufficient support to go on living. This, in itself, should prevent a change in the law.

“End-of-life doctors warn that ‘assisted dying’ would undermine palliative care for all Scots. Psychiatrists warn of a harmful shift in our societal response to suicide. And sociologists caution that a change in the law may open the door to more permissive legislation. The tragic experience of other nations suggests it is a matter of when, not if, laws expand.

“Opposition to a change in the law is found among people with different beliefs – atheists, humanists, agnostics, and people of faith. It is motivated by both personal and professional insight. Our campaign seeks to present a range of arguments, from diverse perspectives.

“We would urge MSPs to reflect on the evidence and arguments set out in this report and vote against ‘assisted dying’. We need to chart a better path forward for people with terminal illnesses and others in Scotland. To do this, MSPs must oppose a change in the law.”

Palliative care

Dr Juliet Spiller

Still Not Safe includes evidence from Dr Juliet Spiller, an Edinburgh-based palliative consultant with more than 20 years’ experience. Dr Spiller states:

“The idea that you can focus on providing access to assisted suicide and providing access to palliative care is misguided. You can’t do both. We observe from other countries that, as soon as you introduce assisted suicide as a treatment, the quality of palliative care is reduced. We can’t afford to be one of those countries that follows suit.

“There’s no question that an ‘assisted dying’ law would very negatively impact wider access to palliative care. I think one of my biggest worries is that if you catch people in a bad period, and you hear that expression of ‘I wish I was dead’ and you act on that, the opportunity for any further value of life is gone”.

Suicide prevention

Professor Allan House

Allan House, a professor of liaison psychiatry and expert in the overlap between physical and mental health, stresses a potential impact on suicide prevention:

“There is a wider risk to society when you legislate the idea that certain suicides are to be supported – in other words that there are some people whose lives are not worth living who should be helped to end their lives. That’s a more intangible risk, but it feels to me like the greater risk long term.

“It seems to me this would reduce the drive to prevent suicide. Instead of assisting suicide in people who think their lives are intolerable, we should be working to stop it being the case that people with severe physical illnesses find their lives intolerable”.

The report also warns that people experiencing poverty are at “particular risk of injustice under an assisted suicide law”. Professor House adds:

“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.”


Dr Miro Griffiths

Dr Griffiths argues that a change in the law would impact marginalised groups:

“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 also highlights personal experience of negative value judgments taking place within healthcare, which he says 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.”


Dr Ashley Frawley

Sociologist Dr Ashley Frawley points to troubling evidence from her home country of Canada: “There are now cases in which people have chosen ‘assisted dying’ because they cannot afford to live in their community. Their disability payments are not high enough and because they have a long-term illness, they’re eligible for ‘assisted dying’, they’ve opted for that.

“I think we have to think about the issues with our public healthcare systems, which are stretched and struggle very much to deal with very costly treatments for people. The end of life is also a very complex thing to think about. When exactly is the end of life? And in what context would people feel that the onus is on them to end their lives?”

A better way

The report acknowledges that “keeping the door closed to this practice is not enough”, adding that our “society needs to outline a better path for people with terminal illnesses, and other groups involved in this debate”.

Asked about a better way forward, Dr Miro Griffiths MBE 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.”

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.”

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.”

About Better Way

Better Way 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 

Read our report: Still Not Safe

Contact us: