End of Life (Scotland) Bill Terminated

On 1 December 2010 the Scottish Parliament voted overwhelmingly by 85 to 16 to reject Margo Macdonald's End of Life Assistance (Scotland) Bill at its first stage debate. The Bill sought to legalise assisted suicide and voluntary euthanasia in Scotland.

There was an impassioned debate between MSP’s with some changing their minds against the Bill after hearing witness evidence. One MSP reported a postbag of 10:1 against the Bill, despite the claims by Margo MacDonald that 77% of Scotland’s population supported the principle of the Bill.

The key points of controversy raised by MSP’s were the lack of clarity in the Bill’s terms and intentions; autonomy; undue influence; dignity; conscientious objection and the relationship between medical staff and their patients; and whether the de-criminalisation of assisted suicide stood in opposition to progress in palliative care and medical research.

Parliament heard that the Committee which consulted on the Bill received over 900 submissions with only a small number advocating the Bill. Objections to the Bill ranged from the importance of the sanctity of life to the practical considerations involved in making ‘end of life assistance’ available to everyone, including those in remote areas, when most doctors and nurses were likely to have a conscientious objection to participating in the killing of their patients.

Commenting on the result of the vote, Gordon Macdonald of the Care Not Killing Alliance, said: 

'This is a fantastic result and a victory for the most vulnerable in our community. The detailed scrutiny and exhaustive investigation that this Bill has had over many months and the sheer magnitude of its defeat should settle this issue in Scotland for a generation. 

MSPs have voted overwhelmingly today to reject in principle the legalisation of physician-assisted suicide and euthanasia in Scotland recognizing that such a move would seriously endanger public safety. They have instead sent a ringing endorsement to making the very best palliative care widely available and accessible.

The key argument that decided this vote and the similar votes in the House of Lords in 2006 and 2009 is a simple one. The right to die can so easily become the duty to die. Vulnerable people who are sick, elderly or disabled can so easily feel pressure, whether real or imagined, to end their lives so as not to be a burden on others. 

Parliament’s first responsibility is to protect the vulnerable and that is what they have voted to do today.’

Debate Details

Angela Constance MSP reported that in the Netherlands, where regulation of assisted suicide and voluntary euthanasia is the most stringent in Europe, 550 lives were ended last year without any request from the patient concerned. Three other MSPs observed that requests for assistance with committing suicide would decrease if better care was taken of the vulnerable; if more energy was put into high quality pain relief management; if action was taken to make life tolerable for the disabled properly; and if the elderly were treated with more respect and their dignity preserved in the latter stages of life. Another MSP contended that the evidence showed that modern pain control was very effective and the argument that double-effect pain relief was overstated and was no basis for the legalisation of assisted suicide.

Many other objections to the principle and practicalities of the Bill were raised including the difficulty for doctors and psychiatrists of determining whether the patient was under undue influence to end his or her life, or indeed whether he or she was simply feeling a burden and that having the choice to end his or her life was creating a pressure to do so. The subjectiveness and width of the Bill’s terms were significant concerns with estimates of those who might take advantage each year stretching to 1,000 or more.

Michael McMahon MSP pointed out that the question ‘Have you ever thought that your life was not worth living?’—a routine question used in palliative care to diagnose suicidal thoughts—might be seen by the vulnerable as a cue to consider assisted suicide if the Bill were to be passed. ‘Vulnerability is part of our humanity’ and ‘should be respected, not exploited’, he said; ‘coercion can be very real’. His assessment of the Bill was that it was ‘dangerous and unnecessary’; if an opportunity had been missed to diagnose depression, all safeguards in the Bill would fail.

Nanette Milne MSP expressed her firm belief that the decriminalisation of assisted suicide and voluntary euthanasia would risk undermining the trust between doctors and their patients. She called the Bill’s title ‘euphemistic’. Michael Matheson MSP found the Bill’s concept of personal autonomy inherently contradictory and said that both personal autonomy and the right to a private life and a family life sometimes had to be tempered in the interests of wider society.

Karen Gillon MSP spoke openly of her Christian faith and the views of her constituents, who had convinced her that she must vote against the Bill. Angela Constance MSP said that she had been persuaded by the arguments on autonomy that the Bill was very damaging to wider society and that it failed ‘to take into account our interconnectedness’. Another MSP spoke of the slippery slope that the Bill would create and of the fact that we all know suicide is wrong. She reminded the Parliament that we operate as individuals in a society and that we have no right to elevate our autonomy above the needs of society.

Yet another MSP reminded those present that a person’s assessment of their life as ‘intolerable’ could be affected by the actions and inactions of others and that being dependent on others did not automatically make life intolerable. Mike Rumbles MSP spoke of hopes and fears unnecessarily raised by the debate and stated that a society in which it was normal to bring human life to an end was not one in which he wished to live. He urged MSPs to resist the temptation to legislate because of opinion polls, but instead to take the advice of Edmund Burke, who advocated the use of judgment over popular opinion.

The debate was brought to a close with Margo MacDonald attacking religious MSPs and recommending that MSP’s not kill the Bill at this stage. Thankfully, MSPs did not heed her words.