This is Prospect’s rolling coverage of the assisted dying debate. This page will be updated with the latest from our correspondent, Mark Mardell. Read the rest of our coverage here
5pm
Liam McArthur, the author of Scotland’s assisted dying bill, celebrated his victory in the Holyrood debate last night, claiming history had been made. He said: “This is a landmark moment for Scotland.”
He is right—it is the first time members of the Scottish parliament have voted in favour of such a bill, having rejected similar measures twice in the past. But the stage one vote is exactly what it says: the first stage. The second stage is when any MSP can suggest amendments, but they are only debated and decided in committee. When they’ve done that a new (amended) version of the bill is published. Then and only then does the parliament get to stage three—the final vote.
Still, all the indications are it will eventually become law and those who want that to happen are delighted.
Ally Thomson, director of Dignity in Dying Scotland, said: “This is a watershed moment for compassion. MSPs have today taken a historic step towards greater choice and protection for dying people.”
But he added: “Significant though this moment is, in the months ahead we will join him in working with MSP colleagues on the amending stages to ensure that a new law is as robust as it can possibly be. Today, MSPs have voted for choice, safety and compassion. They have expressed the will of the majority of Scottish people and have made history. Now we must make the choice of assisted dying a reality.”
MSPs voted for the bill by 70 to 56, with one abstention—Health Secretary Neil Gray, who explained this was in keeping with the Scottish government’s neutral stance. According to the Herald, this was a bigger margin than supporters expected. But that didn’t stop Gordon Macdonald, chief executive of Care Not Killing, welcoming the closeness of the vote.
He commented: “In an ideal world, MSPs would have rejected this dangerous and ideological bill today, however we are greatly encouraged by the closeness of the vote, which no one predicted when the legislative process started over 12 months ago. The simple explanation is the more MSPs hear what legalising assisted dying would mean—rewriting the NHS charter, fundamentally changing the nature of health care in Scotland and how it would put pressure on the terminally ill, vulnerable and disabled people to end their lives prematurely, the less inclined they are to back it.”
Even though the Scottish vote was expected, it is a relief for Kim Leadbeater. Had it gone the other way it would have been a grave setback for her Westminster bill.
“I’m pleased that after a lengthy, constructive and compassionate debate, the Scottish parliament has voted in principle in favour of changing the law to address the injustices in the current ban on assisted dying,” she said. “MSPs listened to the voices of those with personal experience of those injustices and concluded that the status quo cannot be defended any longer.
“It was those voices that helped persuade a majority of MPs in Westminster to support the Terminally Ill Adults (End of Life) Bill in principle last November. While parliament has been looking in detail at the bill over the past six months, more people have suffered painful deaths and other families have confronted the risk of prosecution when a loved one travelled to Dignitas or took their own life. It is right that we take time to consider the legislation with extreme care, however, and when it returns to the Commons on Friday it will do so as an even stronger, more effective bill thanks to the evidence-based, constructive changes we have made in committee. I look forward to colleagues approaching the next stage with the same respect and civility they showed in November—and that MSPs have shown.”
Liam McArthur confessed to nerves as he made the opening speech, and not only because it would be the longest speech he had made in his 18 years as an MSP. “I know how much this bill matters to those dying Scots and their families who are desperate to see the law changed to allow more choice, compassion, and dignity at the end of life,” he said. “And it’s their voices. They must be at the centre of this debate, at the heart of our considerations and at the forefront of our minds as we come to vote later on this evening.”
McArthur acknowledged that many other MSPs felt conflicted, were “wrestling with many profound, complex and sensitive issues, and who are anxious about not being seen to make the wrong decision.” However, he urged them to vote in favour of the general principles of the potential change in the law. “It’s surely not tenable for parliament once again to say that this is all too difficult and to refuse to undertake the work required to see if a bill that commands majority support and public confidence can be agreed.”
Scotland had debate assisted voting twice before—and twice rejected it. The last time, in 2015, it was by a big margin: 82 to 36. McArthur has learnt from those debates.
He noted that some disability groups and campaigners had raised concerns about the potential impact of the bill on efforts to improve the rights and lives of people with disabilities, and noted the “urgent attention” is required to address the social stigma, inequalities and inadequate support they face, including at the end of life.
“However, it would be a mistake to conclude that we should oppose legalising assisted dying for terminally ill people until those wider problems are fixed. It’s paternalistic to imply that reducing choices will resolve inequalities. Denying dying Scots more choice will not enhance the lives of those with a disability, nor do I believe would it be acceptable for a person with a disability who needs meet the eligibility criteria under my bill to be denied the same choice as anyone else.”
As he concluded his voice broke with emotion, and he seemed on the point of tears.
“This is not a binary choice. It’s not a case of palliative care or assisted dying. It should be about providing the best possible support and care for dying people, and that includes ensuring they have access to the full range of options, including the option of an assisted death, should that be what they wish, within a robust, safe, and compassionate legal framework.
“Colleagues, we don’t get to choose how we die. But we can choose how we are treated when that time comes. And for some, that means being able to say, ‘enough’. To avoid suffering that cannot be alleviated. To die peacefully, surrounded by loved ones, on their own terms.
“That is not giving up on life. That is not choosing death over life. It is choosing how we spend our final days. It is choosing compassion. It is choosing dignity.”
McArthur concluded by noting that the Scottish parliament “has often been at the forefront of progressive change”—and by reminding colleagues again that they were not yet being asked to pass the final bill, but whether they wanted “to continue the process of scrutiny, to consider amendments, and to see whether we can arrive at a law that reflects the will of the people and respects the views of this chamber.”
On Friday, Westminster will be back in the spotlight, where MPs will be debating the final version. It is a nerve-wracking week for supporters and opponents of a fundamental change in the law.
14th May
2pm
The Royal College of Psychiatrists has come out against Kim Leadbeater’s assisted dying bill, which will be back in the Commons on Friday. It has said: “With too many unanswered questions about the safeguarding of people with mental illness, the College has concluded that it cannot support the Bill in its current form.” It called on MPs to “consider” its “serious concerns”.
On Radio 4’s Today programme Nick Robinson questioned the registrar of the Royal College, Dr Trudi Seneviratne, on the reasons for its decision.
TS: There are several concerns. First of all, there’s the issue of suicide. When someone has a terminal illness—terminal cancer, for example—they may well develop depression or another mental disorder. That can lead to feeling suicidal and wanting to die. But if you treat the depression, that suicidality might lift.
The bill as it stands makes no requirement for an assessment of someone’s mental disorder or suicidality. That’s really important.
NR: Let’s deal with that one. If the bill were amended to say there ought to be such an assessment, would that change your mind?
TS: Well, that is only one of several factors, I’m afraid. There are many issues in the bill as it stands that would need to be addressed—but that is certainly one of them.
NR: So what else are you looking for?
TS: There’s another issue around what we might call a holistic assessment of someone’s unmet needs. There’s no provision for that currently in the bill.
When people are experiencing things like intolerable pain, financial hardship, social isolation or housing difficulties, they may well want to die in that context. But there’s no provision for a holistic assessment, and clinicians aren’t even asked to speak to loved ones or others in the person’s network to consider those factors. That’s another really critical area that’s got to be looked at.
NR: Again, I might ask the same question: if provision were made, would you change your mind?
TS: Again, that is one of the points.
NR: My sense is, as you list the points, that there’s no chance you’ll change your mind at all. What you’re basically saying—while pretending to remain neutral as a Royal College—is: “We’re opposed to assisted dying. We’re not going to back it.”
TS: Well, no, that’s not the case.
NR: Then what can MPs do to convince you?
TS: There are a number of points regarding this particular bill that need to be addressed. In fact, we have outlined nine points we want MPs to consider. Those two are among them. There’s also the issue of the psychiatrist’s role. Our role is to assess mental disorder and to look at treatment. As it stands, what we’re being asked to do is more of a tick-box exercise—deciding whether what other people have said is correct or not. That can’t be the case. That can’t be our role.
There’s another important point about the number of psychiatrists. The workforce simply isn’t there. There’s a huge increase in mental disorder across the board, and we don’t have enough.
***
On the programme, Robinson was right to point out how hard it would be to meet all these concerns—which are a rather mixed bag, combining several wish-lists with professional worries, ranging from the patrician and utopian to naked self-interest. In the former category is the demand that the bill takes in to account “financial hardship and inadequate care or housing”, which could only be met by either a commitment to end the ravages of poverty or by excluding the poorest from access to assisted dying.
The latter category includes the statement: “It is not clear what a psychiatrist’s role on a multidisciplinary panel would be: If this Bill proceeds in England and Wales, any role a psychiatrist plays in an AD/AS process should be consistent with the core duties of the profession, including determining whether a person’s wish to die can be remedied or treated.” This is, at least, within the remit of the bill.
And then there is the special pleading for more jobs for psychiatrists: “There are not enough consultant psychiatrists to do what the Bill asks: As things currently stand, mental health services simply do not have the resource required to meet a new range of demands.”
The NHS 10-year plan is on its way and mental health is a key priority, so we will have to see how far this demand might be met—but I doubt it will satisfy the Royal College.
Marxists used to make “impossiblist demands”—militantly urging workers to ask for changes so far-fetched, so radical that they were bound to be rejected. The theory was when this happened the disappointed people would be so fed up that they would become more open to revolutionary politics. The list of demands here suggest opponents of the bill seem to be using the same tactics.
13th May
The Commission on Palliative and End-of-Life Care will publish its report this evening, after six months of work and hearing hours of evidence from 128 witnesses. The stated aim is to “set out a vision for the care that someone should receive at the end of life in a range of settings” after identifying the current strengths and significant shortfalls in provision.
The two prominent politicians at the heart of the commission have assured me that the fears of some supporters of Kim Leadbeater’s bill—that the commission is simply a front for opposition to assisted dying—are quite unfounded.
Why were some of Leadbeater’s supporters so concerned in the first place? Their suspicions were raised because the commission was set up by two of the most prominent and ardent opponents of assisted dying, Labour MP Rachael Maskell and the cross-bench peer and senior medic Ilora Finlay. Maskell set up the commission shortly after the vote in November in favour of Leadbeater’s assisted dying bill, when numerous MPs argued increasing funding to palliative care was either an alternative to a change in the law or a necessary part of it. Now critics believe it is not a coincidence that it will be handed to the health secretary, Wes Streeting, and made available to MPs just days before the controversial bill is back in the commons for a series of critical votes.
The pair of politicians are both fiercely opposed to what they call “assisted suicide” and are stalwarts of the all-party parliamentary group Dying Well, which has the official dual aim of not only promoting excellence in palliative care but also to “stand against the legalisation of doctor assisted suicide”.
Today’s report will only do the former—according to Finlay, its main author. She told me: “Assisted dying (assisted suicide and euthanasia) are no part of our remit and we have not inquired into the issue.” Both politicians firmly reject the suggestion that Care Not Killing has been involved with the commission in any way. Having read an embargoed (until 6pm) copy of the report I can confirm that assisted dying is only mentioned in passing once.
However, there is still an aspiration that it will influence the coming stages of the debate. This presumably means it may provide ammunition for those who want to argue that it is wrong to spend NHS money on assisted dying without radically increasing the funds going to palliative care.
Improving access to palliative care has certainly been one of Finlay’s driving passions. She’s a dynamic character with an astonishing career as both a consultant and a professor of palliative medicine with a focus on pain management. A stylised poppy, symbolising morphine, appears on her coat of arms as a reflection of her specialisation.
As a political campaigner, she’s lobbied against smoking in public places as well as sun beds, carbon monoxide and cheap alcohol. And, of course, against assisted dying. She told the Lord Speaker’s Corner podcast: “I have my concerns based on what I’ve seen from other countries where they have changed the rule, where actually it becomes too easy for people to view death as a solution.
“It takes clinicians away. It’s been estimated that it takes about 60 hours of clinical time to really process a request properly. Well, I would prefer that you spend 60 hours of clinical time improving people’s quality of life. And I think it’s very easy to clock into a message of despair. And that actually we need to be saying that people’s lives are important. We need to help them live as well as possible for as long as possible. And I’m very concerned about saying that you license doctors to provide lethal drugs to patients... It would be wonderful if every doctor, every nurse was well motivated. But goodness me, we have seen disasters in this country of people abusing their position, to say the least. And of almost clocking into a culture of death, which is dangerous.”
She told me she “led on writing the report with consultation for the chair, Professor Sir Mike Richards, Rachael Maskell MP and supported by our secretariat, Grace Hawkins, with specific input from several commissioners”.
In a separate email Maskell told me: “I sought to set up the commission as I recognised the need for better palliative care, not least as people were sharing their experiences of dying which demonstrated poor provision in so many cases. Where good medicine was present, these circumstances were not occurring. It came, therefore, from my own clinical curiosity and having looked at this issue on the health select committee in the last parliament, and from the evidence being provided by Hospice UK, Sue Ryder, Marie Curie and other palliative care providers. As a former clinician myself who worked with patients who were dying, I recognised that the inequity of provision needed urgent attention. I therefore have a keen interest in this issue in parliament.
“With regards to Care Not Killing, they have no part of the commission, so I am not sure where this is coming from.”
It comes in part from the last name on the list of those who helped support the commission—Grace Hawkins, a former Care Not Killing administrator—and the perception that opponents of assisted dying have been prominent in helping the commission.
As one insider told me: “These links to ideologically driven organisations are difficult to escape and undermine the commission’s claim to impartiality on assisted dying. Understandably there’s a worry MPs aren’t going to be able to take the recommendations at face value.”
Finlay rejected the suggestion that the commission is “tied up with CNK (Care Not Killing)”. She wrote: “Grace Hawkins was employed by them for a short time in the past. After that appointment, she came to work for the commission and is employed through Hospice UK for that role; she has no contact with CNK in this role.”
The big question is, who is paying for the commission? Finlay suggests cost are very low, with the commissioners “all unpaid and receiv[ing] no reimbursement of any sort, not even travel”.
I asked if all four organisations listed as supporters contribute financially. “A small grant from Hospice UK (with some contribution from Sue Ryder) allowed a secretary to be employed and a small grant from the Association of Palliative Medicine allowed a part-time researcher,” she said, adding that no organisations not listed contribute financially, nor do any individuals provide significant financial support.
Perhaps this low-cost model could be adopted by the next royal commission!
The reaction to the publication, on both sides of the debate, will be interesting to say the least. Watch this space.
12th May
It’s a very big week for medically aided dying in the United Kingdom, with not just one but two big parliamentary occasions, first in Edinburgh tomorrow and then in London at the end of the week.
It seems that this Friday won’t be quite as critical for the Leadbeater bill as we once thought, or at least it won’t be the last chance MPs get to vote it down before it is sent to the Lords. That’s because most private members’ bills have the report stage and the third reading rolled in to one, but most at Westminster think it will run for several Fridays to come. Although no one really knows what the speaker will decide, many think it would be a bit shabby if he didn’t allow two days for report stage and another one for the big vote itself. All will (probably) be revealed on Thursday.
The very similar bill in Scotland faces its stage one vote, which means the MSPs vote on the general principle of the bill. It has already been though the committee stage. There’s a lot more detail on the procedure on the excellent Scottish government website.
The man behind the bill, Liberal Democrat MSP for Orkney Liam McArthur, says he’s confident and that the people of Scotland are “desperate” for this to become law. His confidence is probably justified, but the bill faces quite considerable headwinds—not least first minister and leader of the SNP John Swinney’s announcement that he was going to vote against it, setting out his concerns in great detail. Despite his protestations that this is not his intention, this may well sway loyal MSPs, even though this is a free vote.
Swinney doesn’t mention faith as a factor, despite his recent declaration that while he’s not a member of the Catholic Church as his wife and son are, he regularly worships with them. He says that despite voting against similar bills twice before, he “agonised” this time before deciding to vote against.
He said: “There are three fundamental reasons why I have come to that conclusion. Firstly, I am concerned the passage of this legislation will fundamentally alter the relationship between patients and clinicians. In my view, there is a real danger of undermining the role we all believe is effectively performed by medical professionals of protecting and enhancing human life.
“If any possibility, or indeed obligation, is applied to medical professionals to advise patients about assisted dying, I judge the relationship between doctor and patient would be changed in an irrevocable and detrimental fashion.
“Secondly, I’m concerned about those who are vulnerable in our society, and those who may consider themselves a burden to their families or to the state, may feel undue pressure to end their life prematurely.
“I’ve read carefully the views of many individuals and organisations on this point, and I can see no means of avoiding such a situation emerging in relation to the Bill.
“Thirdly, as much as I recognise the efforts to tightly define the Bill, if a decision is taken to pass this legislation, then I am not sufficiently confident there will be no further developments through the judicial process that could see the provisions of the Bill extended to take in other, broader, circumstances that would extend the intentions of Parliament.
“And I would not wish to enable such an undesirable situation to develop.”
He’s joined by Humza Yousaf, former leader of the SNP and first minister before Swinney, who also said he’d vote against. Yousaf said there were “not strong enough safeguards” to prevent vulnerable members of society from being coerced into ending their life under proposed legislation.
There’ll be lots of demonstrations for and against outside the Scottish parliament tomorrow. One of them will be the star of the TV programme Silent Witness Liz Carr, who is vehemently opposed to what she regards as dangerous plans to legalise assisted dying. She said: “Liam McArthur’s Bill is dangerous for older, ill and disabled people across Scotland – even more so than Kim Leadbeater’s Bill being considered in Westminster.”
She added: “To qualify for assisted suicide under the Bill a person must have an “advanced and progressive disease, illness or condition from which they are unable to recover and that can reasonably be expected to cause their premature death.
“As someone who as a teenager was told by doctors that I wouldn’t live to be old because of my condition, this definition applies to me.
“The McArthur Bill is not just about terminal illness; it’s about disabled people.
Fraser Sutherland, CEO of the Humanist Society, accused some opponents of scaremongering: “We know the Scottish public are behind assisted dying. Now we need MSPs at Holyrood to be brave,” he said.
“Those who understand what this bill means know that it has never been about putting vulnerable people at risk, or denigrating the brilliant work that goes on in palliative care settings across Scotland. It is about bodily autonomy, choice, and compassion.”
There are few new arguments in this debate, whether in Scotland or England and Wales, but we’ll hear a lot of repetition this week of ones that have become very familiar.
To my mind, the suggestion that some disabled people will want to use the law to kill themselves–not because they really want to die, but because they believe they are a burden on the state or their relatives—is by far and away the most serious objection. It is also very depressing.
Recall Swinney’s words: “I can see no means of avoiding such a situation emerging.” He is right. No clever drafting, no new clause or tighter wording can ever protect people from their own perception of their lack of worth. Laws can protect people from the words and deeds of others but no law in the land can change the way you think about yourself.
Critically, no current law attempts to stop someone killing themselves because they feel a burden. Indeed there are currently no safeguards at all, no obvious way of prosecuting someone maliciously inflating that sense that your life isn’t worth living. The fear is, presumably, that getting a doctor to prescribe a lethal dose is easier than procuring one yourself—or indeed finding a road or a tall building. Really? Even when you have to have (or fake) a terminal illness and persuade two doctors and a retired judge that you genuinely want it all to stop.
I don’t think that is true. I can’t know for sure of course. But if people want to kill themselves because they feel worthless that is a problem for all of us, a flaw in society not in these two bills.
