Keep the political ideology away – this far is too important.
In the last few weeks, an analysis of the consultation process on the proposed Assisted Dying for Terminally Ill Adults (Scotland) Bill, being advanced by Liam McArthur MSP, has been released.1 The debate about this highly sensitive topic has been played out in various forms in both Holyrood and Westminster over the past 16 years.
There is no doubt about the widespread concern for those suffering in terminal illness and this bill seeks to address this by advancing a particular solution. It should be noted that such concern for individuals suffering in this way is shared by those who are opposed to assisted suicide.
There are many and complex aspects to this debate and having read the 91 page consultation summary document there is no doubt in my mind that the message has been drafted and interpreted in a very particular way. The consultation process is designed to be open and participatory and the outcome ought to be fairly represented. The public require honesty and transparency in this process. It is most disappointing that the report is pushing a particular agenda and that there is evidence of both fudge and spin in the concluding message. To clarify these terms – I regard ‘fudge’ as being the selective and dubious interpretation of the results and ‘spin’ represents the weaving of a thread of truth into the fabric of a lie. Sadly there is evidence of both in this document. Perhaps, given the involvement of organisations such as Dignity in Dying Scotland, the Humanist Society of Scotland and Friends at the End we should not be too surprised at the flavour of the interpretation given to the responses..
Important aspects of assisted suicide need to be fully discussed in a public forum and I will return to these in future posts. My purpose here is to comment on the consultation summary.
It is impressive that over 14,000 responses were recorded – more than any previously proposed Members Bill in the Scottish Parliament. A total of 81 came from organisations and 13,957 from individuals. Overall, the document suggests that a clear majority of respondents (78%) were either fully or partly supportive of the proposals almost an 80:20 split. Quite how one can adequately gauge the representative effect of organisational responses as compared to those from individuals does leave the quantification of actual community support shrouded in some mystery.
Furthermore, taking that overall message at face value also needs some careful handling. For example it is evident that some 3352 emails, fully opposed to the proposals, have been discounted. If, as I would strongly argue, these had been included rather than simply ignored – a rather different outcome emerges. The level of notional support within the terms of the consultation ought to more accurately record 17,014 responses. Only 62.8% were supportive and 37.2% opposed. Much closer to a 60:40 split. It is very clear that a much more detailed, careful, informed and accurate consideration must now take place.
The summary document does reflect many of the important issues. Here are just some of the questions and issues that merit careful reflection.
- Why is it the case that pain and inadequate symptom control present a small minority of the reasons that people seek assistance in dying? In reality, a much higher proportion of people seek assisted suicide for other reasons. Some feel that they are a burden, or that their lives have been completed or that there is a sense of duty.
- To legalise assisted suicide would introduce the incongruity that some suicide would be permissible and some would be illegal. Suicide is strongly discouraged for those who feel that their lives are not worth living.2 Assisted suicide introduces state supported termination of life for others who come to the same conclusion. There are clearly rational issues that need to be teased out to make any sense of this.
- Safeguarding is a major concern. Good legal safeguards already exist and the introduction of similar legislation in other nations has uniformly led to extension of the policy to other vulnerable groups in society.
- Autonomy is important. However can the value individual choice be considered to be more important than a detrimental effect on the wider community?
- If it could be guaranteed that death could be civilised, humane, compassionate and dignified, such an aspiration would be laudable. A professional palliative care service seeks to provide exactly that outcome. Surely such services require investment and extension rather than the introduction a system allowing the eradication of patients.
- Assisted suicide would utterly change the relationship between doctors and patients. For healthcare professions to assist a patient to take his or her life undermines and harms the fundamental principles that subtend of the doctor-patient relationship.
- The idea that assisted suicide allows a peaceful, dignified death is an unfortunate fiction. The drugs used to terminate life can be difficult to take, can produce distressing symptoms such as nausea, vomiting and severe pain. In fairness the consultation does recognise ‘frequent concern’ about aspects of the prescribing and delivering of intended life-ending medication.
- There are real concerns that the eligibility for assisted suicide would be extended following the introduction of a law such as is proposed. For example the speed with which the situation in Canada has moved from a position as proposed by this legislation to euthanasia by lethal injection for individuals irrespective of capacity and even irrespective of terminal illness.
No doubt this debate will continue, and so it should. In future articles we’ll have a more detailed look at these points.
For now, my real concern is that the consultation analysis which will be attached, as a memorandum, to the Bill when it emerges, gives an inaccurate, skewed and ideologically driven view which fails to properly account for all the responses which have been made by members of the public.
David J Galloway