30 December 2009

A good death in Scotland (2)

In this, my final blog post of the old year, I wanted to return to an issue that will be profoundly pertinent in the new one. Thus far, the Scots blogosphere has been notably quiet about Margo MacDonald’s private members bill to legalise physician assisted dying. I’ve made a view sallies, attempting to lance media misinformation and anticipating some of the conceptual troubles which might waylay MacDonald’s reforming efforts. No doubt interest will heighten when the story marches more resolutely towards the top of the public agenda, and various interest groups, outraged opponents and vocal supporters get torn into one another. In anticipation of that melee, today I wanted to cover a couple of aspects. Firstly, what do we know about the Scottish public’s attitude to legalising assisted dying along the lines Margo proposes? On the basis of this thumb through the available polling data, I want to draw out a lesson or two about how defining the ambit of the debate may be critical, if Margo is to prevail. This will be no mean feat, considering how awkwardly incompatible viewpoints, beliefs and arguments about assisted suicide or dying abut.

In the clammy, neurotic minds of professional politicians, presented with the perpetual threat of being given their jotters by shadowy elections looming, public opinion can never be far from their thoughts. What do we know about public attitudes to assisted dying? Firstly, take the Populus poll, commissioned by the Times on the 19th of July, asked 1,504 people for their views on a number of social issues. Among them, whether doctor-assisted suicide should be legalised. Infuriatingly, moronically, the pollsters asked the 66 Scots interviewed the following, inaccurate question:

“Currently it is illegal in the UK to assist a person in committing suicide. There have been a number of reported cases of people travelling to a Swiss clinic where they can legally be given drugs that will cause their painless death. Most, but not all, of those taking this course of action have been suffering from terminal illness.

Do you think that, in cases where an individual is of sound mind and has made unambiguously clear that they want to die and want or need help to do so, the law in the UK should or should not be changed to legalise doctor-assisted suicide, similar to what is practised in Switzerland, so that a doctor could assist someone to commit suicide without facing prosecution?”

Regular readers will be familiar with how vexed I get by these misrepresentations. Assisting suicide is categorically not illegal ‘in the UK’. I vent more fulsomely on the theme here. However, these quibbles aside, of more decisively interest politically are the Scots voter’s answers (despite the relatively thin sample) to the affirmative proposal . 39/66 said that they thought that “the law should be changed” – 70% of the total sample. 15 said the opposite, or 28% of the total. One soul admitted that they didn’t know how they felt. Matters get more murky when non-doctors are introduced into the question above. Asked whether friend, partner, family members or spouses who assist suicide should be able to do the same and avoid imaginary prosecutions, public confidence is lower. Of the 66 hailing from Scotland, only 49% answered ‘yes’ – contrasting very sharply with some of the other regions – Wales and the North of England, for example, answered ‘yes’ to the tune of 67%. 46% of the Scottish sample opposed the idea, with 3 folk, or 5% undecided.

Matters get even more foggy when the poll disintegrates into a series of unclear and conceptually imprecise questions about voters’ attitudes to particular conditionals. Should it be permitted if an individual is terminally ill, chronically, in extreme pain, if the individual ‘has severe physical disabilities – even if otherwise healthy’? Shifts and variations mark responses. Lack of conceptual clarity is everywhere in evidence. An obvious objection is that sixty six people is not a robust, statistically significant spread of views. From the perspective of cautious MSPs, too few perhaps to sooth their easily startled hind-consciousnesses, apt to be frightened off. More confidence might attach to the results of the only other recent study of the people’s views. Conducted by Cello MRUK, the pollsters asked 1000 people in Scotland whether the law should be changed to allow doctors to help people with chronic illness who want to die to end their lives”.

Unfortunately, the poll and its detail does not seem to be available online, so here I’m relying on the figures cited in the Times commentary. 68% of respondents said yes, only 8% said no while a whopping 24% said they did not know. Another interesting detail from the Times piece concerned different respondent age groups. “Support for a change in the law was highest among people aged 35-44, 78% of whom backed MacDonald’s proposals. Among those aged 45-54, 55-64 and 65 and over, support for the bill stood at 77%, 73% and 63% respectively. An equal proportion of men and women supported a change in the law.”

1,000 folk is clearly a more respectable roll of opinion. Assuming Margo’s proposal can survive parliamentary procedures, we can probably expect one or more of the papers to invest in another, hopefully more expansive and more unrestrictedly reported round of canvassing of public attitudes. If I had the cash, I’d lay out myself – but alas – the year’s profits from my peat worrying enterprises isn’t sufficient. Our curiosity will just have to feed on what we already know. I’d suggest that in combination with the Times micro-poll, both polls demonstrate a couple of things. Firstly, that public opinion clearly favours legal changes for some people, under some circumstances, probably constrained, probably by a medical professional. Bambie tribunes can be reassured somewhat, that if they wrestle their consciences into supporting the measure – they can be emboldened by the support of much of the populace. However, politically, we just don’t know how much the voters care – namely, the cost of support or the tariff of opposing Margo’s proposals cannot be enumerated cleanly. In terms of detail, of seeking a careful and specific and precise legislative formulation, however – I’d speculate that the public common is in as many minds as it has heads.

Much of this can be put down to the amazingly complex, philosophically befuddled range of categories, arguments and accounts of assisted dying which we can give. I went into this question earlier this year, when I asked ‘is a real debate of physician assisted dying possible’? That commentary remains cogent. Although I understand the Maximum Eck’s natural conservatism has probably got the better of him, and he remains ‘unpersuaded’, I’m glad to hear that the SNP are to have a free vote along with the rest of the Parliament. Frankly, I’d have been astounded if it had been anything otherwise. Hopefully unpersuaded denotes persuadeable in Alex Salmond’s case. As I argue in the foregoing post, one of the main problems which Margo will face is framing the debate in a manner which results in her bill being passed. What arguments, what conceptual terms of reference will be most disposed to sway doubters? Alternatively, what justifications for will best deflect critiques certain to be levelled against the proposals?

Having read through Margo’s consultation exercise, her emphasis is clearly on the current absence of and pre-eminent need for clarity in law about these issues. Here are three quotes from that document:

“The proposal that persons who wish to decide when to end their lives should be able to do so, legally, with the assistance of a registered physician has come about because of the experiences of people with degenerative conditions, terminal illnesses and those who become entirely dependent on others following a trauma.” (Margo MacDonald 2008, 3)

Anticipating the sorts of debates which will hasten on the heels of her plans, MacDonald wisely concedes the obvious – that

“… in a pluralistic society such as Scotland, there will be differing beliefs and opinions on this question. It sits at the interface of private morality, public policy and the law. But there are ambiguities and a lack of clarity around the issue that, at the very least, indicate the need for examination of our current law and practices.” (MacDonald 2008, 3)

Given that admission, how to approach the problem? Assuming that she sticks with the same rhetorical tactic emphasising autonomy, the core of her argument is and will be that:

“A patient’s right to end of life choices is based on the principle of autonomy, that a person has the right to determine the quality of his or her own life and its value, unrestricted by the moral, cultural, religious, or personal beliefs of others.” (MacDonald 2008, 4)

The debate is thus being thrust into the medical domain, its actors are doctors and patients, their choices medical, emphasising the personal, the particular, interference in those choices by the state a sort of tyranny, prosecution of those who assist described in the same terms we would use to elucidate the oppressive persecution of a minority by the majority. Criminal laws pass every year in Holyrood, state agents are sanctioned to apply force to the corrigible citizenry – yet those votes are rarely free. MacDonald may well be optimistic about her parliamentary chances, since conducting a free vote precisely concedes her point – that the question is one of personal morality, conscience, not your usual law and order fare. If MSPs should vote on the measure, largely “unrestricted by the moral, cultural, religious or personal beliefs of others”, why then should those members of the public not do so also? If tribunes are to decide autonomously, what greater right have they to dictate than the ethical voices of the ordinary man or woman to reach and articulate their own conclusions?

It is this sort of reasoning which could usher the Assisted Dying (Scotland) Act into law. I for one would very much support it.


  1. A wonderfully & conscientious setting out of the discussion ahead Lallands and I'd tend to agree with your conclusions.

    The “unrestricted by the moral, cultural, religious or personal beliefs of others” sentiment would appear to lend itself to some form of plebiscite, such is the importance of this fundamental issue.

    I will watch with interest the development or Margo's private members bill and like you will very much support the Assisted Dying (Scotland) Act into law.

  2. We have no choice in coming into this world but we need a choice when we wish to leave it. I suspect that those who oppose are doing so from a religous standpoint.

  3. I don't oppose the expectation of those who are suffering according to their individual perception of what untenable living is to receive relief from and/or assistance to end the pain of their continued existence. My fear is the process being hijacked from the medico-legal parameters of professional medical ethics and practice within the law and 'managed' by the variable employers of NHS doctors and nurses. I would also commend the remarkable work and success of the palliative and terminal care resources that we have - whose efforts in the UK, in particular, are seldom bettered.
    I have no religion - but I have been subject to and seen too many others suffer from the odious religion of NHS bureaucracy.

  4. Not the Messiah,

    For myself, I don't foresee a referendum on the subject emanating from the parliament any time soon. That said, if Margo's Bill fails, I imagine something along those lines, given the poll numbers mentioned, might be a possibility.

  5. cynicalHighlander,

    Certainly, folk who adhere strongly to an ethic of sanctity of life - particularly divine sanctity - will undoubtedly make a vocal contribution to the debates on the subject. Indeed, without citing the divinity, Alex Salmond expressed his dubieties in terms of just such a woolly ethic.

    If anyone is interested in a sharp, provocative philosophical attack on that sort of thinking, albeit largely ignoring the religious dimension, you can't do much better than Peter Singer's 'Rethinking Life and Death: The Collapse of Our Traditional Ethics'.

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