25 May 2015

Assisted Suicide (Scotland) Bill RIP

On Wednesday afternoon, Holyrood will debate the general principles of the late Margo MacDonald's Assisted Suicide (Scotland) Bill, probably for the last time. If MSPs endorse the Bill's general principles, it will speed on through the processes of parliamentary amendment and scrutiny. If they knock the proposals back, that will be the end of the matter. The Health and Sport Committee produced a critical but patchy Stage One report on the draft being shepherded through parliament by Patrick Harvie, but declined to make a recommendation on how MSPs should vote on Wednesday. Once again, this one is between individual parliamentarians and their consciences. 

It seems very likely that the majority will exercise these to assist the Bill to an early end, disgareeing to its general principles, which would introduce a procedure and safeguards to allow individuals to be assisted to kill themselves if certain conditions are met. The debate in the last session, rejecting Margo's first Bill, was considered, personal, and did the parliament and its members credit. We can only hope that the discussion this week reflects those values and principles. But for campaigners, supporting this Bill, the outcome is likely to represent another disappointment. 

In the ferment of the referendum and general election campaigns, the reforms being proposed and the arguments for and against introducing them have flown under the radar, somewhat.  Attention has, understandably, been elsewhere. But in rejecting this Bill, parliament is not closing the issue -- merely deferring difficult questions. 

The Lord Advocate believes the law on assisting suicides in Scotland is crystal clear and that prosecutors and the police know a crime when they see one. I disagree. As do a number of other weightier scholars and commentators on our criminal laws. Profound uncertainty continues to characterise basic questions about what kinds of assistance are and are not criminal under Scots law.  

Would I be at risk of prosecution if I prepared a fatal dose of drugs for a sick friend to administer to themselves? Might I face a homicide conviction and life imprisonment for ordering tickets to bear a terminally ill relative to Switzerland? At least these questions have forced their way onto the agenda in the discussion of this Bill, but essentially, we have been left none the wiser about how the Crown Office understands and analyses these scenarios. As have the families and friends of people for whom these are not abstract questions of legal principle, but real, flesh and bone decisions to be taken in the midst of great suffering and trauma. That can't be right.

The polling evidence suggests, and has suggested for some time, that our parliamentarians may be out of step with public attitudes. According to research published in the Sunday Herald yesterday, 73% of folk polled sympathised with the general principle of the Bill, though this fell significantly after the commissioners of the poll -- Christian Action Research and Education -- put a series of increasingly gruesome and ghoulish claims and scenarios to people about the alleged impact of introducing the legislation.  For opponents of assisted suicide, this is vindication. When the punters hear the evidence and the arguments, their support for the idea bleeds away, they argue.

Be that as it may, the underlying conclusions of this poll echo what we have seen in many others. Their MSPs may be overwhelmingly opposed to the idea of legalising assisting suicides, but the people are more sympathetic -- or at least more open-minded -- to the idea of legislating in this way. Some of the opposition to this Bill is down to implacable, principled objections. To ethics, religion, concern about how, as a society, we choose to make the lives of some people intolerable, worries that dealing death would corrupt the vocation of healthcare professionals, and fears about the various slippery slopes which opponents of assisting suicide fear the nation may skid down.  I wouldn't want to underestimate the force of these arguments or the sincerity of individuals, in voting against assisted suicide on their account.

But there is a sneaking suspicion that some MSPs will oppose the legislation for an easier life politically. Anxious to avoid responsibility. Anxious to avoid being caught in the headlights of a well organised, well funded and vocal interest group with another Holyrood election pending. Social conservatives must hate Patrick Harvie anyway. He has nothing to lose. But the same cannot be said for many of his colleagues whose fingers will be hovering over their voting buttons on Wednesday. This isn't exactly an admirable basis to oppose the legislation, but the impulse is an understandable one for all that.

But assuming the Care not Killing talleymen have called it right, and that between two thirds and three quarters of MSPs will reject this Bill, it is back to the drawing board once again for proponents of this legislation. Perhaps a change of strategy is in order? A succession of attempts to guide these proposals and cognate ideas through parliament have foundered on both sides of the border. The objections have frequently been fair, often technical, but ultimately -- these Bills have failed because the simple underlying proposition failed to convince the parliamentary majority. Complaints about the lack of clarity or problems with the safeguards are, and have always been, only pretexts to dump the Bills.

Do campaigners keep plugging away at the idea until its time has come, in the hope and expectation that the majority in the legislature will eventually shift? Or is it time to give up trying to persuade MSPs of the merits of the proposals, and instead, to persuade them that the people should be given a say, via a referendum on the general principle? Perhaps there are neglected litigation strategies -- parallels to the English case-law in Pretty and Nicklinson -- which could be exploited in Scots courts to put pressure on the Crown and to keep the issue on the political agenda?

But with three defeats in as many parliaments, deprived of their most forceful and charismatic advocate in Margo MacDonald, and little progress being made, these questions of strategy and future tactics can't be avoided.


  1. The objections to assisted suicide are among the most illogical and inhuman arguments ever made in the name of politics. We permit the end of suffering in "lower" species while still safeguarding animals against being killed needlessly. Is it really beyond our wit to extend the same principles to ourselves? What are the real reasons that our legislators resist this basic act of compassion and decency?

    1. As a vet, I'm very ambivalent about the whole thing. And that's speaking as someone who has administered euthanasia more times than I can possibly remember.

      Allieviating agony when the patient is in extremis and certainly going to die within minutes or a few hours should never be a problem. It shouldn't be a problem in human medicine either. Anaesthetics are legal - vets use them too, we just up the dose a bit. If the patient is unconscious until the end comes, job done, even if it takes more than the 10 or 15 seconds it would take us to do it.

      One problem seems to be that while this appears to have been common practice in human medicine in the past, the increasing emphasis on the illegality of euthanasia seems likely to have inhibited the practice. Physicians are unwilling to go that wee bit too far in case they're prosecuted, and as a result may sometimes not be going far enough.

      The idea that people are being starved and dehydrated to death is utterly abhorrent. If a vet were to do that, we'd be prosecuted for causing unnecessary suffering and struck off quite frankly. Either go with the anaesthesia, even if it brings on the inevitable more quickly, or treat your patient properly with food and water.

      A colleague of me wrote eloquently about the death of his wife from pancreatic cancer. In the last month all efforts of the Macmillan nurses failed to control her pain. My colleague said he would never have left an animal in that condition, and if it hadn't been for the effect on their children of having their father jailed for killing their mother, he'd have gone for it. That's the sort of circumstance that makes me incline ot support the bill. But having said that, I don't understand why an anaesthetic couldn't be administered, or keep going with the morphine even if the palliative dose turns out to be a fatal dose.

      It's the further-out situations that concern me. I've seen too many decisions made for social convenience. That's allowable with a pet, it is not acceptable with a relative. And I'm sorry but the safeguards don't look too safe from where I'm sitting. The availability of euthanasia completely alters the dynamic of the physician when dealing with an ultimately terminal situation where the stage of intolerable terminal agony hasn't yet been reached. I'm on the fence, because I see exactly where the medical objections are coming from.

    2. sorry about the typos. Colleague of mine; inclined to.

    3. The right reverend will surely acquiesce to the logic that human life and animal life are qualitatively different in all fashionable philosophies and that human life not animal life is sacred, or at least imbued with unique characteristics which make it inherently worth preserving.

      My own opinions notwithstanding, it is clear that this is the motivation of the bill's opponents and it is doing the debate a disservice to start out by equating humans to horses wholesale.

      (I must declare an interest: I have a broken leg and I approve of the fact that they set it in a cast rather than murder me with a bolt gun)

    4. To be fair, the reason they shoot horses in that situation is that medical and surgical treatment of long-bone limb fractures in horses is pretty much always doomed to utter disaster. It's another example of shortening the agony in extremis.

      If a horse could recover the way a human patient will recover, we'd do it. But they can't. They don't do "bed rest".

    5. "The right reverend will surely acquiesce to the logic that human life and animal life are qualitatively different in all fashionable philosophies and that human life not animal life is sacred, or at least imbued with unique characteristics which make it inherently worth preserving."

      He certainly would not, and nor would he accept the killing of an animal for "social convenience".

    6. RevStu:
      'He certainly would not, and nor would he accept the killing of an animal for "social convenience".'

      Agree again. Whitman -

      'I think I could turn and live with animals,
      they are so placid and self-contain'd,
      I stand and look at them long and long.

      They do not sweat and whine about their condition,
      They do not lie awake in the dark and weep for their sins,
      They do not make me sick discussing their duty to God,
      Not one is dissatisfied, not one is demented with the mania of owning things,
      Not one kneels to another, nor to his kind that lived thousands of years ago,
      Not one is respectable or unhappy over the whole earth.'

  2. I support the assisted suicide bill. I wonder if those against would feel differently if they had a relative or friend who was suffering needlessly. Having seen my grandpa irreversibly waste away from a muscle-degenerative disease, I know the pain, both physical and mental (the loss of autonomy and independence etc) that people are subjected to by disease. Towards the end of his life, he was completely dependent, bedridden, and unable to enjoy the things he once had. Even eating had become a stuggle, as well as watching tv, having conversations etc. He was no longer the intelligent, witty, warm grandfather I had once known but was almost a ghost. It was heartbreaking, and for me it's impossible to see how extending his pain could be considered compassionate.

    1. My neighbour (and friend) died of motor neurone disease. It was totally pitiful. She could not swallow, speak, or eat. She communicated through sign language which she'd learned although a hearing person. But she fought it all the way, to the very last minute. She never wanted to die. I guess people are different, but did your grandfather want to be exited by others? I support the right to die, but at what point does it become social convenience?

  3. Andrew: 'But the same cannot be said for many of his colleagues whose fingers will be hovering over their voting buttons on Wednesday. This isn't exactly an admirable basis to oppose the legislation, but the impulse is an understandable one for all that.'

    That impulse will be there for sure, but while I have little faith in politicians in general, the majority of our Holyrood lot did back gay marriage, despite the Holy Willies such as Sootie Stagecoach and Bashir Maan growling on the sidelines.

    This is a more difficut one, but - agreeing with RevStu for once - having seen too many awful last acts in my time I hope the Bill passes.

    Wish Margo was here to fight the corner. A great loss to Scotland.

  4. As always well argued; though provoking and probably right .
    There is a wider matter you refer to [ post defeat ] on the possibility of the use of a referendum .
    That raises some potential fascinating discussion about the possible principled place of referenda in our public decision making . This is regardless whether as veto on the choices of representative democracy [ pending EU ref ? ] or initiative [ as you suggest here ] . Hhmm . chin scratching called for I think

  5. Maybe a staged approach would work - make it legal to help procure and prepare drugs but not to administer them, make it legal to help people to make travel arrangements and accompany them to any foreign jurisdiction where it's legal. Not ideal at all but steps which might win enough support and could help prepare the ground for greater parliamentary acceptance in the future. A referendum may also be an option but whether it would simply be an argy-bargy or a thoughtful debate depends greatly on the quality of the campaign run by the sides in favour and against and the willingness of the media not to treat the issues and arguments in sensationalist or trivial fashion. As the recent Irish referendum campaign on same-sex marriage shows, a public airing of issues with well-made contributions from those who are most personally affected can produce a compassionate and fair response from most of the public.

  6. Margo's bill wasn't just aimed at the terminally ill but those who wanted to end it all because their lives lacked dignity. There are many people with MS whose lives lack dignity. Can you imagine what it is like not being able to wipe your own backside? Day after day? Having somebody else do it for you? Not being able to cook or even feed yourself? Yet most of these individuals soldier on, as do their friends and families. I support the right of people being able to say, 'Enough!' and end it all. But there is something deeply worrying and abhorrent when society starts agreeing that yes, some peoples lives are not worth living, because how different is that from saying that their life is worthless?

  7. I'm interested in what Rolfe says about the use of anaesthetics for the terminally ill being more common in the past, but that nowadays doctors are less likely to over-use it for fear of being accused of euthanasia.

    My Dad told me that when his Dad was dying of stomach cancer in the 1960s, and clearly he wasn't going to see out the summer, the pain got so bad that he never left his bed and the nurse was coming regularly to give him shots of morphine. On her last visit she left an extra large dose in a big syringe and told Dad that should he get worse in the night and appear restless, to give him that. So they did. And within a couple of hours he had passed peacefully. I thought that was generally the way the terminally ill were gently eased out of this world.

  8. I think the Irish gay marriage referendum shows us which way to go. The religious social conservatives think they are a large majority. They will ignore opinion polls and make our elected representatives feart but only a referendum will prove how wrong they are. I agree it should be on broad principles: I want the Parliament to pass an assisted dying bill in the next parliament. Kind of thing. It can be run contemporaneously with the election next year.

    If the bill fails I think therefore we need to get a petition up for a referendum. I have confidence in the Scottish public on this issue and we need to show the religious bigots and social conservatives how far behind the public curve they really are. Then anytime they try it on again say wrt abortion or sex ed in schools we can wave the petition result in their faces, with the latest polling and ask if they want to go again.

  9. BTW as a scientist licensed under the Animal Experimentation Act to perform specific procedures on animals and be responsible for them I was subject to strict conditions and one of them was that any animal under my care who was suffering too much (defined) must be humanely dispatched at the earliest opportunity. I did this even when the animals were part of running experiments and losing them weakened the statistical power of the experiment. Not to do so would have made me liable for a fine of several thousand pounds AND/OR up to 6 months imprisonment.

    You can and often will be taken to court by the SSPCA for maltreating an animal yet human beings capable of pleading to be allowed to die cannot be treated similarly by their own choice.

    Thus a mouse in a lab has more right not to suffer than you or I do.