‘Assisted dying’ threatens Scots battling drug and alcohol addiction

Annemarie Ward

The issue may have receded from newspaper headlines, but Scotland is still in the midst of a drug deaths crisis. There were 1,197 suspected drug deaths last year and data from Public Health Scotland shows 294 suspected drug deaths between December and February – a rise on the last quarter. With all that’s going on in politics, it’s vital that this isn’t forgotten.

Across Scotland, vulnerable men, women, and children are at risk of dying due to addiction – devastating families and whole communities. A frightening number of people are affected. The most recent data suggests that around 50,000 people in Scotland are addicted to opioids, making them most at risk of becoming a part of Scotland’s harrowing statistics.

Alcohol addiction is also hugely concerning. The number of people in Scotland whose death was caused by alcohol is thought to have risen to the highest level in 14 years, with at least 1,276 alcohol-related deaths in 2022. This tragic situation is made far worse by our beleaguered healthcare infrastructure. Scots are simply unable to get the support they need to truly escape the terror of addiction, stay free, and find the tools they need to rebuild their lives.

It is so, so important for struggling people to be shown compassion and offered a genuine way of escape. This is what my charity, FAVOR UK, is seeking to secure through our work, and policies such as the Right to Recovery Bill, which is due to be debated in the coming months.

At present, I’m acutely aware of trends in wider society that threaten the safety and dignity of the people I serve. The situation on the ground with regard to rehabilitation is dire. Beds don’t exist to meet demand, and the NHS is wholly unequipped to deal with other problems. A mental health tsunami, compounded by the pandemic, is breaking upon our services right now.

It is in this, troubling, context that MSPs are considering the next controversial piece of legislation at Holyrood: an ‘Assisted Dying Bill’. This bill, currently undergoing Stage 1 scrutiny by the Health, Social Care and Sport Committee, would allow people to access drugs that they can take to end their lives. It’s the third attempt we have seen for this kind of law in Scotland.

I consider this Bill to be a serious threat to the vulnerable people I advocate for day in, day out. And I regret to say that concerns about these people have not really featured in this debate so far. I’d ask MSPs to think about them as they engage with arguments from various stakeholders.

I note that the Bill itself makes no provision for access to assisted death to be limited if a person is addicted to drugs or alcohol. In fact, its authors appear to want the opposite outcome. Explanatory Notes published with the Bill state that people with a terminal illness should be barred from accessing assisted death if they are suffering from a mental disorder. But they add:

“A person is not suffering from a mental disorder only due to…dependence on, or use of, alcohol and/or drugs, [and] behaviour that causes, or is likely to cause, harassment, alarm or distress to any other person, or by acting as no prudent person would act. This means, in particular, that a terminally ill adult should not be deemed as lacking capacity on the basis that their decision seems unwise”.

The meaning is clear: a person’s eligibility for assisted death should not be denied because of addiction to drugs or alcohol. This is staggering. Every professional, family member, and friend of a person in the grip of addiction will tell you that their judgment is severely affected. It would be a dark irony if vulnerable people who have spent years trying to escape drug addiction are deemed eligible to die by ingesting lethal drugs because the state does not consider them vulnerable enough to be protected. For me, this is the opposite of compassion.

It’s also troubling that doctors’ assessments outlined in the Bill do not require consideration of people’s wider circumstances. It’s obvious that a person who is deemed eligible for assisted suicide under the Bill’s broad definition of terminal illness will be influenced by various factors, including their experience of drugs and alcohol – perhaps stretching back years.

A woman who lacks a strong support network who has relapsed repeatedly may feel that she has no prospect of happiness in the months or years ahead of her and choose assisted death. This scenario is made more likely in a context where support for drug and alcohol addiction is inadequate. Nothing in the Bill as it stands would prevent a tragic death of this kind. Nor a death that was influenced by poverty, acute loneliness, or factors.

Proponents of the Bill talk of ‘safeguards’ but there are simply no guarantees, whether we are talking about doctors’ assessment of their health, or capacity, or exposure to coercion. Mistakes and abuses happen, inevitably. An NHS on its knees makes them more likely.

We must also consider international evidence. For example, a friend in Canada knew someone who opted for ‘Medical Aid in Dying’ not due to their qualifying physical health condition, but because they had relapsed after 20 years of sobriety and could not find the support that they needed to regain their sobriety. People will face this kind of dilemma if ‘assisted dying’ is legal in Scotland. It’s dangerous to open the door to it in a context of such severe inequality.

Several countries have progressed much further with their ‘assisted dying’ laws to allow people with non-terminal conditions, disabilities, and mental health conditions to die. This too is a risk, and there is no guarantee that Scotland will not follow suit in years to come.

In my view, ‘assisted dying’ would open the door to new, terrifying injustices against the people I serve, and other groups in society. It is not safe, and it cannot be made safe. We need to find other ways of helping people who are struggling at the end of their lives. I believe that we can.

Annemarie Ward is CEO of Faces and Voices of Recovery (FAVOR UK)