WHEN privileged groups impose bespoke ethics to remove humanity’s unsightly wrinkles, it’s usually the powerless and the marginalised who suffer the unintended consequences.

Professor Leonie Herx is one of the world’s leading health experts in palliative care and bears witness to the horrific effects of the Assisted Dying programme introduced in her native Canada.

“In Canada, we’ve been living in a regime of assisted dying for six and a half years and the reality of where we’ve ended up is not what was intended when we started. It’s quite horrific, actually and so it’s important for those considering this type of legislation in Scotland to get a full picture and consider all the unintended consequences of it.

“Most troubling of these is that, as the legislation has expanded well beyond what we were told would only be very rare and extreme cases of suffering, it’s society’s most vulnerable groups who are being caught in the net.

“It’s now become very difficult in palliative care to do our work when medically assisted dying becomes a default solution for some patients. In the past, when people said ‘I can’t go on like this’ we’d have brought in the palliative care team to look at all facets of that individual’s suffering. Now it’s too often understood and interpreted as a request for euthanasia.”

Professor Herx has been visiting Scotland to address politicians as the Assisted Dying Bill proposed by the Lib Dem MSP Liam McArthur makes its way through Holyrood. A letter sent by more than 150 Scottish health care professionals to the Health Secretary Humza Yousaf has expressed deep-rooted concerns about the bill and says that the existing law should remain unchanged.

According to Professor Herx similar concerns raised in Canada about their MaiD (Medical aid in Dying) legislation have been borne out to a chilling and sinister extent. Those considered incapable of fully “contributing” to society are now deemed a cost burden and, as such, have found themselves in the cross-hairs of a capitalistic and predatory euthanasia programme.

“In Canada our parliamentary budget office assessed the cost of expanding the legislation and found it would save the Canadian Government hundreds of millions of dollars per year on healthcare. Reports are now emerging of health care administrators advising euthanasia as an option to patients because the cost of their care is considered too high.

“At the outset, we were told that a ‘carefully designed and monitored system of safeguards’ would limit harm and any risk of wrongful death of vulnerable persons. Yet, every year since, there have been documented cases of non-compliance with safeguards and misapplication of both law and policy.”

In 2016 Canadians were told that legalised assisted dying would be reserved only for exceptional circumstances of intolerable suffering. Yet it’s since been incrementally expanded by subjective and loose interpretations of the law.

As the initial parameters have expanded, Canada has begun to witness increasing numbers of cases where people have been requesting euthanasia because of extreme poverty, lack of access to housing and their inability to afford access to basic care home facilities. Underpinning much of this has been a sense of despair brought on by loneliness and depression.

The professor cites a notorious and distressing case, covered widely in the Canadian media. “One 93-year-old woman, whose family shared her story, experienced so much depression from being locked in her room during Covid that the thought of another lockdown was more than she could bear.

“So she requested euthanasia to avoid another Covid lockdown. This shows where this can go. It will disproportionately affect those who are lonely or depressed or who are on the margins of society and can’t afford to live well.

“It’s characteristic of a very ableist and ageist society that our healthcare system is discriminatory against them. Now we just offer death as an easy and cost-effective way out.

“Military veterans who are suffering from PTSD and having suicidal thoughts are being offered euthanasia by case workers, There’s now an inquiry into why so many of these brave people who had risked their lives for their country were being offered this. People are shocked by how quickly we got here.”

In 2022, Scottish palliative care doctors were asked by the Association for Palliative Medicine (Britain and Ireland) for their views about the implications of embedding assisted dying within the healthcare system. The survey found that nearly all of them would refuse to participate in assisted dying and that a large majority felt the legislation would adversely affect palliative care services. Crucially, it would compromise access to care by vulnerable groups.

An overwhelming majority of them believed the proposed legal safeguards were not fit for purpose as they wouldn’t prevent harm to vulnerable individuals and would be unable to prevent coercion. Almost half of them would resign if their organisation undertook assisted dying.

Professor Herx believes that profound ignorance of what palliative care can achieve in alleviating chronic suffering informs much of the debate.

“There’s often a lack of understanding about what ordinary dying looks like. You can go right through medical school without seeing someone die naturally. Western society now seeks to push away the reality of death. We now turn to long-term care homes when once our shared sense of community supported caring for people in our own homes.

“We’ve lost our understanding of those normal, physiological changes that happen with ageing. I’ve been practising palliative medicine for 16 years and I’ve yet to encounter someone whom I’ve been unable to help make comfortable at the end of their life. We have exquisite tools that are improving all the time to assess patients’ needs and medications to help different and complex suites of symptoms. These can be therapeutically delivered along with constant assessment and reassessment of potential side effects.

“Doctors are good at the physical aspects of palliative care, but we’ve also learned that in order to alleviate suffering you really have to dig deep and understand who that person is; what they’ve experienced in their life; their resilience and how they’ve faced past challenges.

“We need to understand what past hurts are left unhealed; what questions they might have about what comes next, including the fear of not being remembered. Addressing the whole person is key to addressing some of their suffering. If someone is in pain and we can’t get it under control, then we take a step back in their palliative care and say ‘maybe there’s something more going on here’.”

The way in which the Canadian euthanasia laws have been manipulated and distorted to pursue a path of least resistance is now heading inexorably into eugenics, or survival of the fittest. Canada’s disability community have called it precisely that because the expanded legislation includes disability as a reason in and of itself to have your life ended. And you’re more at risk if you’re voiceless, powerless and without sufficient funds.

Says Professor Herx: “We have clear evidence from Canada and other countries that have legalised assisted suicide that it’s those made vulnerable by poverty who’ve been put to wrongful and premature death. Many of them could have lived well for another few years if they’d been given the right supports and funding to do so.”

Of course, you don’t get to mount such a global and sophisticated campaign that distorts the realities of state-sponsored euthanasia without very deep funding reserves. And so, as was ever thus when affluent, middle-class neo-liberals attempt to manipulate outcomes it’s always best to follow the money.

The Dying with Dignity lobby have an international network and have succeeded in shaping the way this has unfolded. In Canada, according to Professor Herx, they are very powerful and have a lot of money. “They’ve influenced the way the Canadian media has told this story. No lobby group has had more meetings with politicians than Dying with Dignity. Such access doesn’t come cheap.

“The Canadian disability community believes that the people driving this are often white, worried, wealthy individuals who want control over their own life and death. One of my fellow palliative care specialists calls this ‘privileged autonomy’.”

It’s the ultimate designer accoutrement available to those who have who have the means and resources to remain healthy for longer: the privilege of designing their own deaths. Those with far less and with far less chance of living healthily have no such luxury.