‘Assisted dying’ legislation before the Scottish Parliament is “not reassuring” for anybody worried about the risks, a senior psychiatrist has said.
Allan House, a professor of liaison psychiatry – which concerns the overlap between physical and mental illness – cites a number of serious flaws.
In an analysis published by Better Way, Prof House warns of over-broad eligibility criteria, unworkable safeguards, and the prospect of mission creep.
On the issue of eligibility, he states:
“The defining features of terminal illness in the Bill are that it can reasonably be expected to cause the adult’s premature death, that it is advanced and progressive and that it is a condition from which the adult is ‘unable to recover’. These sound like substantial constraining criteria, but they are not. Most people imagine that ‘terminal illness’ is synonymous with ‘about to die’ but ‘advanced’ has no standardised definition and is not defined further in the Bill or the explanatory notes. The definition, far from referring only to a small number of people in their last days or weeks, covers large numbers of the population.”
Assessing the proposed “clinical and social” safeguards, he states:
“Apart from certain bureaucratic requirements – proof of identity, age 16+ years, residence in Scotland for at least 12 months,registration with a medical practice in Scotland – the only medical or other requirements are the presence of terminal illness as defined in the Bill,presence of mental capacity as usually defined legally, and absence of coercion by others. Mental health is only considered to the degree to which it impairs mental capacity. No detailed attention is given to the complex business of howto identify coercion”.
“The main direct risk in assisted dying legislation resides,however, not in these usually floated ideas about mental incapacity or coercion but in the risk it poses to people who see no other choices – maybe living alone and lacking social or emotional support, financial security or psychological resilience. These are the risks for suicide associated with physical illness and they would be the focus of any careful assessment of a person encountered in clinical practice who said they wanted to end their life.It hardly needs saying that they do not resemble in any way the features of the self-confident, articulate and well-connected celebrities fielded by campaigners and the media in support of assisted dying legislation.
“Given these risks, the assessment process looks dismayingly thin. There is no requirement to explore social or psychological factors such as those routinely explored in other settings when somebody has thoughts that life is not worth living – for example the ambivalence or sense of helplessness or hopelessness that might accompany such thoughts – or to know anything about the individual’s personal background or social circumstances.
“There is no requirement to know about previous mental health problems or, for example, previous episodes of self-harm or attempted suicide. Neither is there a requirement to contact or discuss the case with the person’s usual medical practitioner or other clinician who knows the person or to examine the person’s medical records. There is no requirement to contact the person’s next of kin (even for a 16-year-old) or any other informant – not even the person who witnesses the “declaration” of desire for assisted suicide or euthanasia.”
On the threat of mission creep, Professor House adds:
“There is a longer-term legal question that is mentioned only tangentially. McArthur’s Bill is presented in a libertarian framework of autonomy and the right to personal choice and in the policy memorandum it is argued that notwithstanding the ECHR’s lack of enthusiasm for the idea ‘the Bill proposed would enhance a person’s human rights’. This rights-based argument has been used in other jurisdictions to extend the initial remit of assisted dying legislation on the basis that it is discriminatory not to do so. In Paragraph 28 of the Policy Memorandum we are told that the Bill has more in common with legislation such as that in Oregon than it does with legislation such as that in Belgium and the Netherlands, without even a nod at the history of legislation in those countries and Canada where an initially restricted eligibility has been rapidly expanded in the name of rights and equity.”
He concludes:
“Reading McArthur’s Bill is not reassuring for anybody worried about the risks that are posed by legislation aimed at legalising assisted suicide or euthanasia.”
ENDS
About Allan House
Professor Allan House is emeritus professor of liaison psychiatry at the University of Leeds. He has worked as a consultant liaison psychiatrist in the NHS and as an academic, researching and teaching in Nottingham, Oxford and Leeds. His areas of interest are the overlap between physical and mental health, especially in people with severe physical illness, self-harm, and suicide.
About Better Way
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