Thread by @jmgillies

🧵Some thoughts on Scotland's latest #assistedsuicide proposals.

On Sunday, it was announced that a bill to legalise doctor-assisted suicide in Scotland will be brought before Holyrood. This is hugely dispiriting for those who have opposed this move in recent years.

Assisted suicide - or, as it is euphemistically termed ‘assisted dying’ - has already been comprehensively rejected both by Holyrood and Westminster several times.

The evidence from other jurisdictions, from those working with patients at the end of life, from disabled groups and others always indicates that a change in the law would be too dangerous. Nothing has changed.

Sadly, campaigners don’t seem to care about the evidence. Using hyperbolae and fear-inducing rhetoric, they present the current law as cruel and demand ‘choice’ for people at the end of life. Of course there are difficult cases and we all sympathise with those who are suffering.

I have personally seen someone very dear to me go through the anguish of terminal cancer. But the current law is far from cruel. And choice is by no means an absolute. Individual liberties must be curtailed when one’s actions present a threat to other people.

Giving certain patients access to doctor-assisted suicide would affect every person in Scotland living with a terminal illness by putting an unprecedented option before them: 'I can end it all. Should I?' And it would radically alter the relationship between patients and doctors.

In a context where NHS budgets are stretched, and lonely, forgotten-about people die without proper support, it should be unthinkable. Patients would undoubtedly feel pressure to die. And medics may feel under pressure to encourage the practice.

‘Assisted dying’ campaigners often neglect the effectiveness of palliative medicine and the tireless work of palliative medics, who have shone brightly over the last year of pandemic.

As a country, we don’t invest enough in palliative care. Surely it is foolish to consider the radical step of allowing assisted suicide when we are not where we could be with current end of life support.

Last week, at an event in the UK Parliament, Professor Katherine Sleeman, a distinguished expert in palliative medicine, summed up the situation well:

“Hospice, UK has estimated that every year in the UK over a hundred thousand people die needing palliative care but not receiving it. And more of a concern is that this gap is getting bigger because needs are projected to increase by around 40 percent over the next 20 years.

She added: “Can we really consider legalisation of assisted dying, this seismic shift for all of society, when so many people are dying without the care they require, without even the information that they need?

I do not necessarily think assisted dying is morally wrong, but I am deeply concerned that our societal conversation is being driven by hyperbole and fear not by evidence and information and it's wrong and dangerous to frame this as a choice between suffering and suicide.”

Even the experience of those who support assisted suicide suggests that good palliative care works in the most difficult situations. Last week, one of the foremost assisted suicide campaigners in the UK, Noel Conway, died after a long battle with motor neurone disease (MND).

Mr Conway’s wife Carol Conway told the media her husband had died peacefully, the hospice team and ventilation nurses had shown empathy and concern, and ensured he had a painless and dignified death.

Another reason not to change the law is because assisted suicide would alter the lense through which we view suicide as a whole. In jurisdictions that have legalised 'assisted dying' or euthanasia, there is evidence of a rise in suicide more widely.

A 2015 study from the United States found that making it legal for doctors to assist someone to end their life resulted in a 6.3% increase in total suicides.

The report’s authors concluded that changing the law was associated with “an increased inclination to suicide in others”. Changing the law to allow has engendered a culture change. Suicide is now viewed as more acceptable.

Disabled activists are amongst the most ardent opponents of assisted suicide and euthanasia over the years given the threat these practices pose to their community.

Not Dead Yet states: “Killing is not just another medical treatment option, and it must not be made any part of routine health care…We believe legalising assisted suicide will inevitably lead to increasingly adverse judgements about the quality of life of disabled people.”

In Scotland, disabled MSP Pam Duncan-Glancy and Jamie Szymkowiak, Convener of the SNP’s disability group, were some of the first voices to object to the proposals at the weekend.

Finally, assisted suicide is an ethical Rubicon that should not be crossed. As Dr Calum MacKellar, Director of Research of the Scottish Council on Human Bioethics, has said:

“This move requires society to accept that some lives are unworthy of life. And it means the worth of some lives is no longer considered to be equal to that of other lives. When a society no longer believes in the equal worth of all lives, it is on a very dangerous road”.

It’s so important that MSPs approach this issue somewhat dispassionately, and carefully consider the evidence. As we approach a new debate on a familiar issue, the situation has not changed. Assisted suicide would be a dangerous step.