Before I entered politics, I worked for 14 years as part of the nursing team at the St Margaret of Scotland hospice in Clydebank. It was an incredibly moving, but also immensely challenging, role. Caring for people at the end of their life is not an easy job by any means.
However, it has instilled in me the fundamental belief that those at the end of their life deserve dignity and support. It instilled in me an understanding of the importance of compassionate and well-resourced palliative care. I want to see more focus and support being given to that.
Over the past year, I have met with constituents and stakeholders on both sides of the debate, listening carefully to their views. Although I respect constituents on both sides of the debate, I have decided that I cannot support the bill, for reasons that I will set out.
For many of the supporters of the proposal, it is about autonomy. However, regardless of any supported safeguards, the bill will have unintended consequences for society as a whole. As the Scottish Council on Human Bioethics stated:
“In an interactive society, making a choice about the value of a life … means making a decision about the value of other lives.”
The bill would fundamentally change the relationship between patients and clinicians, influence culture and alter how we view ageing, illness and disability.
I believe that passing the bill would send a message that certain individuals’ lives are less valuable than others and that those individuals are considered a burden on society. That worry is articulated by disability organisations, which fear that the scope of the bill would quickly be expanded to include those with disabilities within the eligibility criteria—and with that can come coercion.
We risk creating an environment in which people feel pressure—however subtle—to choose death to spare others the burden of their care. If we look at other countries, such as Canada, we can see that health reports found that fear of being a burden and loneliness are high up among the top five reasons for people choosing medical assistance in dying.
I fully recognise that the bill focuses on “mentally competent terminally ill eligible adults”,
but we fundamentally cannot guarantee with any certainty that the eligibility criteria will not be expanded in future years. We have seen that happen in Canada, Belgium and the Netherlands, where safeguards have been relaxed, widening access to more groups of people.
Dr Mary Neal, from the University of Strathclyde, has argued that the bill contained many areas that were subject to potential “slippage” and that, irrespective of how tightly the law was felt to have been drafted, there was ultimately no way of preventing people from challenging it.
Although the Health, Social Care and Sport Committee has remained neutral on the bill, it is exceptionally important for members to note that, on the point of a slippery slope, the committee stated:
“The Committee acknowledges that, should it become law, there may be a risk of the Bill being subject to human rights or other court challenges and that this could result in eligibility for assisted dying being extended over time.”
Others share that concern, and members will have seen those briefings. The fact that we are unable to guarantee that strict safeguards would be kept in place is a huge worry for me.
On a final point of concern, the definition of “terminal illness” in the bill is, in and of itself, rather broad. Many have noted that as a concern, including the Scottish Partnership for Palliative Care, which said:
“The definition of ‘terminal illness’ in the Bill is not precise enough … and could mean that people with years to live are deemed eligible”.
That will have a real impact. There is concern, then, that there would be potential for the definition to include a wide range of long-term conditions.
Liam McArthur and other supporters have the best intentions with the bill, viewing it as a way to ease suffering, but the legislation would open a door that we might not be able to close. We cannot, with any great certainty, guarantee that safeguards would be kept in place. That leads us down a very dangerous path of living in a society that devalues the lives of the most vulnerable. Therefore, I cannot support the principles of the bill, and I will vote accordingly.
Top of page picture: St Margaret of Scotland Hospice in Marie McNair’s Clydebank constituency.