Assisted dying: let's have a respectful debate on McArthur's bill

Part of that promise to myself means respecting those who oppose the bill for genuine reasons of personal morality.

I hope the many good people on the opposite side of the aisle to me feel and act the same. The concept of death isn’t something I want to foul with political oneupmanship.

Evidently, those who spread lies and disinformation - on either side - shouldn’t be accorded the same respect, and should, clearly, be called out.

So I’ll try to stick to the facts and leave rhetoric for others. The draft law is a private members bill, from LibDem MSP Liam McArthur. I spent an afternoon with him recently going into the minutiae of the bill.

He’s a staid, sober, old-school politician. There’s no loudmouth bragging. In fact, he’s rather humble and very cautious. He’s garnered strong cross-party support.

The bill is heavily safeguarded. Only those diagnosed as "terminally ill" can apply for the right to die. There’s a "mental capacity" safeguard, where two doctors must agree that the patient fully understands both their condition and the consequences of their choice.

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This law isn’t for people who are mentally ill, depressed, or disabled. It’s only for those with a diagnosis of terminal illness and deemed mentally fit. That’s its foundation. But there are more checks and balances.

Anyone who wants to apply to use the law must be resident in Scotland for 12 months. So Scotland cannot become a "suicide destination" like Switzerland.

There’s a two-week cooling-off period. Medication must be self-administered. Conscientious objector rights exist for medics who wish to opt out.

Doctors are forbidden from suggesting patients access the law. Requests can only come from the patient. If the bill passes, the legislation will be reviewed every five years to ensure it’s fit for purpose, otherwise it ceases to be law.

Mr McArthur’s bill follows what’s known as the "terminal illness" model. This is effectively the same system in some US states, Australia and New Zealand. The alternative is the "permissive" model. This is followed in Canada, Holland, Belgium and Luxembourg.

Under the permissive model a diagnosis of terminal illness isn’t required to access the law. Broadly, the permissive model can be used due to "intolerable suffering".

I agree with Mr McArthur when he says the permissive model and its concept of "intolerable suffering" is “highly problematic”. It’s far too subjective.

In Canada, it was courts which led on the right to die, not politicians as in Scotland.

Canadian courts agreed with plaintiffs who felt their constitutional rights weren’t being respected when it came to the right to die. Parliament then reluctantly legislated.

This made bad law. Moves to expand the Canadian law to allow access for people with mental illness have been paused.

One of the most common and misplaced concerns is that Mr McArthur’s bill will create a slippery slope where Scotland morphs into Canada.

However, terminal illness models don’t metamorphose into permissive models. We’ve seen this proven worldwide. In Oregon, right to die laws have existed since 1997 and eligibility criteria hasn’t changed in 27 years.

joined Dignitas last year and is considering assisted dying if her lung cancer does not respond to treatment (Image: PA)

Scotland’s Humanist Society, which has campaigned for the bill, describes the Canada trope as “the most consistent bad-faith argument used against assisted dying”.

The society’s chief executive, Fraser Sutherland, told me that it was “fundamentally inaccurate. There is ample evidence of jurisdictions around the world where assisted dying laws for the terminally ill have been introduced and have not been extended at all. The ‘slippery slope’ is a mirage”.

Mr McArthur has rightly called for both Holyrood and the nation to focus on the bill he has drafted, not deeply flawed legislation from Canada.

“There’s a desperate need,” he told me, “on the part of some opponents to spend all our time discussing Canadian legislation.”

There are understandable fears around the elderly being coerced by unscrupulous relatives into an early death. However, this fear is misplaced.

In Scotland, only those who are already dying can access the law. Put crudely: why bully your granny into suicide when she’s dying anyway?

In fact, research around the world shows that relatives mostly try to prevent their loved ones accessing such laws, rather than urging them to take their lives.

Support among the public now stands at around 75%. Politicians are finally catching up, and it seems Mr McArthur’s bill will eventually pass into law, unlike earlier attempts at Holyrood which failed, most notably legislation by the late Margo MacDonald, who sadly died from Parkinson’s.

Both Mr McArthur and the Humanist Society say that religious groups now form the main opposition. The healthcare profession - most notably in the shape of the British Medical Association - has moved from a position of opposition to one of neutrality.

Those of a religious persuasion are, of course, entitled to their views. It should be hoped that they exercise their right to express those opinions in an honest way. The Humanist Society fears faith groups will “distort and muddle the debate”.

There is a horrible truth at the heart of this all: we already have a form of assisted dying, except it’s not legislated for, and so therefore not controlled.

There are, as Mr McArthur told me recently, “instances where medics, possibly in discussion with family, sometimes not, are increasing morphine to manage pain in the certain knowledge that it’s significantly increasing the risk of hastening death.

“So we’ve basically got assisted dying - we’re just not either honest about it, transparent, or robust in the way we regulate it.”

That’s a hard discussion for anyone. All of this is hard to discuss. But Scotland is going to have this discussion now the bill has landed in parliament, and for all our sakes we need to debate with respect, honesty and decency.

If we can’t discuss death in a dignified manner, then what sort of society are we?